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Overview
About MMIS
In 1972, federal legislation authorized automated claims processing and information retrieval systems for handling all Medicaid transactions. This is now commonly referred to as the "Medicaid Management Information System," or MMIS. This system was developed to meet the principal requirements of the Federal Social Security Act – Title XIX mandate. The objectives of the system and its enhancements include the Title XIX program control and administrative costs; service to recipients, providers and inquiries; operations of claims control and computer capabilities; and management reporting for planning and control. MMIS is administered through the federal Centers for Medicare and Medicaid Services (CMS). For more information on MMIS visit: http://www.cms.hhs.gov/mmis/
History of Oregon's MMIS
Oregon’s current MMIS was implemented in 1980 and was originally designed to handle paper claims submitted by health care providers and to track the medical eligibility of Oregon’s Medicaid clients. Since then, the system has been expanded and is now used to verify client eligibility, manage health care provider claims and address a variety of Oregon’s Medicaid business needs.
The current mainframe-based system for MMIS was built more than 30 years ago and has become increasingly more difficult and costly to maintain. It was designed for a maximum capacity of 116,000 eligible clients and 260,000 monthly claims. Today the same system is tracking approximately 600,000 eligible clients and processing an average of about 2 million Medicaid transactions each month.
Several factors combine to make the current system unwieldy, complex and inefficient. They include changes in the way health care services have been delivered since 1980; outdated technology; increasingly complex demands of federal, state and local legislation; the implementation of the Oregon Health Plan; and the requirements of the federally mandated Health Insurance Portability and Accountability Act (HIPAA).
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MMIS Replacement Project
The 1999-2001 the Oregon State Legislature authorized DHS, acting through its Office of Information Services (OIS) and Office of Medical Assistance Programs (OMAP), to begin a project to determine the best way to modernize the Oregon’s MMIS.
The modernization of Oregon’s MMIS has been identified as one of 13 state priorities by the Governor. The replacement project will result in significant improvements in the delivery and management of current and future services to clients eligible for Title XIX (Medicaid), Title XXI (Children’s Health Insurance Program), and Waivered Services (the Oregon Health Plan and other community based services).
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Current Status of Oregon's MMIS
On July 7, 2005, with federal approval from CMS, the state of Oregon signed a contract with Electronic Data Systems (EDS) of Plano, Texas to modify an existing Medicaid Management Information System (MMIS) from another state, customize it to meet Oregon’s needs, and install and maintain the new system.
CMS has approved federal funding participation at approximately 90 percent of Oregon’s MMIS replacement cost.
Improvements to the current MMIS will include more efficient claims processing and faster payments for care providers. The new MMIS will also utilize technological advancements that will satisfy federal Health Insurance Portability and Accountability (HIPAA) security mandates.
DHS also contracted with FOX Systems, Inc., of Scottsdale, Ariz., to provide QA and oversight for the project.
DHS News Release, July 11, 2005
Vendor to develop enhanced Medicaid computer system; replaces department's out-of-date technology
Advance Planning Document:
- Update (pdf)
- Attachment (pdf)
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