What is the Medicaid Management Information System,
also called MMIS?
The federal government requires all states to have Medicaid Management Information
Systems to process claims for Medicaid and other medical assistance programs offered
by the states. The system stores and retrieves information needed by governments
to manage medical assistance programs, and audit them.
Why is the state contracting with a new company to
develop this new system?
Federal regulations require states to periodically re-procure Medicaid Management
Information Systems to improve efficiency through competition. The current
system is about 20 years old, and new technology has been developed since Alaska’s
first MMIS was created.
What advantages will the new system offer?
Alaska Medicaid Health Enterprise offers more options for providers. It will make
it easier for providers to do more through a secure and interactive website, such
as enroll in Alaska’s Medicaid program, submit claims and receive payments
electronically. They will be able to find out what amount of the claim will
be paid online. If claims are denied, they can find out the reasons for denial.
This online access to claims will help providers catch errors, which could decrease
the amount of time needed to process and pay claims. Providers will also be
able to receive payments electronically through electronic funds transfer directly
to their banking account.
Alaska Medicaid Health Enterprise will also benefit Medicaid recipients. Recipients
will be able to visit a secure and interactive website to learn more about Medicaid
benefits and coverage, and to find participating health care providers in their
area. Customer service and support also will available through the Internet.
How will Alaska Medicaid Health Enterprise benefit
the general public?
Through the self-service, easy to use web portal, users will be able to find out
about Medicaid, and check if they are eligible for Medicaid benefits.
What will providers have to do when the new MMIS replaces
the old MMIS?
Unless any new federal or state regulations are implemented, providers do not have
to do anything except register via the internet to access Alaska Medicaid Health
Enterprise. Then take advantage of using all the benefits it offers.
Providers who submit claims electronically or who use a clearinghouse will not be
required to change their claims submission process. Providers who submit hardcopy
claims can, however, choose to submit claims via Alaska Medicaid Health Enterprise
so they can see immediately if the claims are approved for payment.
Which providers will Alaska Medicaid Health Enterprise
affect?
Alaska Medicaid Health Enterprise will be available to all providers enrolled in
any of the Medical Assistance programs. Providers will need to do a simple
registration via the net (like registering to access a credit card account) to gain
access.
What does a recipient need to do to access Alaska Medicaid
Health Enterprise?
The recipient would simply need to register on Alaska Medicaid Health Enterprise
in order to access information helpful to them.
Will Alaska Medicaid Health Enterprise be linked to
Division of Health Care Services (DHCS), Division of Senior and Disability Services
(DSDS) and Division of Public Assistance (DPA)?
DHCS, DSDS, DPA and other appropriate staff within State government will have access
to Alaska Medicaid Health Enterprise. The technology within the new MMIS provides
opportunities for improved efficiencies.
What print and save functions will be available through
Alaska Medicaid Health Enterprise?
Print and save functions include:
- A provider will be able to print information displayed on a web page when logged
into the secured Alaska Medicaid Health Enterprise by selecting “print”.
- A provider will be able to save an image of the information displayed on a web page
if, when selecting “print,” they save the image as a “PDF” file. PDF files can only
be created if the provider has obtained, at his expense, the necessary software
(Adobe Acrobat Professional) and installed it on the provider’s computer.
- A provider will have access to certain reports. These reports may be saved to the
provider’s computer. A provider can save the data within certain reports and use
this data in software programs such as Excel.
Further information regarding these functions will be covered during the Provider
Training sessions.
What is "5010"?
"5010" refers to new national electronic transaction standards, known as X12 Version
5010 (5010) and NCPDP Version D.0 (D.0). Under the Health Insurance Portability
and Accountability Act (HIPAA), a transaction must adhere to the standard content
and format requirements if it is submitted electronically. An example of a transaction
is a claim submitted by a health care provider requesting payment for medical services.
Go to
www.cms.gov for more information
about the new electronic transaction standards.
Will Alaska Medicaid Health Enterprise be compliant
with the 5010 electronic transaction standards?
Yes. Alaska Medicaid Health Enterprise will be compliant with the new national electronic
transaction standards, known as X12 Version 5010 (5010) and NCPDP Version D.0 (D.0).
The technical and business changes of transitioning to the use of 5010 and D.0 standards
are significant. The DDI MMIS replacement project team is adding these requirements
into the existing implementation and will make every effort to minimize the need
for multiple testing cycles by health care providers.
