MEDICAID MANAGEMENT INFORMATION SYSTEM - MMIS

Purpose of MMIS

  • MMIS is a database that stores MINNESOTA HEALTH CARE PROGRAMS (MHCP) information.
  • Data entered in MMIS enables consumers to access needed medical services.
  • MMIS system is used to PAY MEDICAL CLAIMS submitted by MHCP providers.

Organization of MMIS

  • Data is entered into MMIS and stored in separate areas depending on the type of information. The primary areas of MMIS are referred to as SUBSYSTEMS or APPLICATION FILES.
  • Each MMIS subsystem performs a specific function and is dependent on data stored in other parts of MMIS.
  • Each application consists of a series of PANELS, commonly referred to as screens.
  • Panels are organized and displayed in a specific order called a QUEUE.

Design of MMIS panels

  • MMIS panels contain FIELDS that display data that was entered into MMIS.
    • Data may be entered manually by a worker.
    • Some fields are auto-populated by MMIS from data stored in another subsystem or generated by the system.
    • Some data, such as most eligibility determinations, have been interfaced from MAXIS into MMIS. MAXIS is a statewide master computer system that determines eligibility for MHCP.
    • Claims for services are submitted electronically by MHCP enrolled providers via MN-ITS (Minnesota Information Transfer System) or pharmacy POS (Point of Sale) and interfaced into MMIS for processing. MN-ITS is the DHS (Department of Human Services) billing system for MHCP claims and other transactions.
  • Information entered in most fields must be a VALID VALUE. Valid values are specific codes that are programmed into MMIS.
  • Some MMIS fields are for text entry. A limited amount of space is available for text entry.
  • Some application files contain COMMENT panels. Workers enter text on comment panels.

How MMIS functions

  • Data entered in a field will affect and will be affected by the information stored in other parts of MMIS.
  • MMIS compares newly entered information with stored information.
  • MMIS posts EXCEPTION CODES (Exception Control Function) to ensure that information entered into MMIS is correct.
  • Workers creating or updating documents in MMIS may need to resolve exception codes (often referred to as edits) that post before the document can be finalized.

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