The Medicaid program, enacted in 1965 under Title XIX of the Social Security Act (the Act), is a  grant-in-aid Medical Assistance Program financed through joint federal and state funding and administered by each state according to an approved state plan. Under this plan, a state reimburses providers of medical assistance to individuals found eligible under Title XIX and various other titles of the Act.

The automated claims processing and information retrieval system is the Medicaid Management Information System (MMIS). The objectives of this system and its enhancements include the management of Title XIX program controls and administrative costs; service to recipients and providers.  It also includes inquiries, operations of claims control and computer capabilities such as front-end web portal access and management reporting for planning, control and agency analysis.  MMIS systems operations are matched by the federal government at a 75/25 ratio.  The federal government will bear roughly 90 percent of the costs of the Medicaid expansion over its first nine years.

Today’s MMIS operations go beyond submitting eligibility and processing claims. It has become the “central nervous system” of a state’s Medicaid program, incorporating electronic health records, data management, imaging and content management tools – while serving as an all-around information portal. The implementation of the MMIS also allows the opportunities to have additional state or federal systems interface to the MMIS that were difficult or unable to be linked previously.  This flexibility helps create a more streamlined, enterprise-wide solution for state Health & Human Services agencies.

Indiana’s implementation of the MMIS is striving to do just that; find a way to automate manual processes, implement a logical and policy-driven automated workflow, and streamline the overall processing of claims for state staffers and the providers that interact with this system.  During the design sessions taking place currently, various FSSA leaders and subject experts are sitting down with the implementation contractor and evaluating current processes, reviewing large numbers of reports and letters (and consolidating some), and having discussions on how this system can be built for the future, even if it isn’t currently happening.

There are a lot of healthcare changes afoot, involving a multitude of stakeholders.  The contractor and state have been, and will continue to, reach out to these important stakeholders to identify how the system changes will impact their involvement in the processing of claims.  These conversations are not only focused on improving existing processes, but understanding how these stakeholders’ technical environments are also advancing to identify efficiencies within the way the systems are built and interfaced.  It is hard to know for certain what MMIS systems, and the policies that drive them, will look like in 10-15 years; but Indiana’s implementation of a configurable Core MMIS system is a step in the right direction, will help foster more coordination and collaboration for all who interact with it and be a model for other states implementing a new MMIS.


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Indiana Awards HP $220 Million Medicaid Contract-