MMIS MAIN MENU
The MMIS menu below displays menu options available to the average user of MMIS. Not all applications or functions available in MMIS are included here.
CLAIMS PROCESSING APPLICATIONS: |
Applications that will be reviewed in this course
CLAIMS PROCESSING APPLICATIONS:
INQUIRY The Claims subsystem uses information from all other subsystems to determine if a provider's claim should be paid and how much to pay. Inquiry area allows worker to view claims.
REFERENCE FILE APPLICATIONS:
PROC, DRUG, DIAG, DRG, UPC The Reference subsystem identifies the data that restricts how each service can be used or billed. Each service is identified with a procedure code (HCPC code). Information for each procedure code is found in the PROC file. Diagnosis codes are found in the DIAG file.
TEXT Text for Exception Control codes, more commonly referred to as edits, is found in the TEXT file. The Exception Control function compares data entered into MMIS with information stored in MMIS and posts edits when there is an error.
PRIOR AUTHORIZATION APPLICATIONS:
PRIOR AUTHORIZATION The Prior Authorization subsystem documents authorization for a variety of services and programs. Prior authorization is required for some medical, dental, supplies and pharmacy needs.
Alternative Care, Waiver, Home Care and PCA services must be prior authorized by entry of a service agreement in MMIS. A service agreement is used to identify the services that the consumer will be provided, the time period, number of units, the provider and the rate that will be paid. Claims submitted by the provider are matched against the service agreement to determine if the claim will be paid. This course will review Waiver and Home Care service agreements.
SCREENINGS The Screenings subsystem holds information for several screening types. This course will focus on the LTC (Long Term Care) and DD (Developmental Disabilities) screening documents.
The LTC screening document is used to record intake and referral activities undertaken by the LTCC (Long Term Care Consultation) team.
LTC screening documents record county preadmission screening of all persons entering a certified nursing facility as required under Minnesota Statutes and under federal OBRA legislation.
The LTC screening document is also used to document eligibility for home and community based waiver programs based on need for nursing facility level of care.
The DD screening document is required for all persons with a diagnosis of developmental disability or related condition entering a certified nursing facility under federal OBRA legislation.
The DD screening document is also used to record assessment and program eligibility determination information for the DD waiver program.
Both the LTCC and the DD screening document provide an important link between assessment, eligibility determination, recipient information, services authorization and payment.
OTHER APPLICATIONS:
PROVIDER FILE APPLICATION The Provider subsystem holds comprehensive information for every provider enrolled with the Department of Human Services (DHS) through the Provider Enrollment unit. Information in the MMIS PROVIDER FILE is entered by DHS Provider Enrollment staff. The Provider subsystem supports claims processing.
RECIPIENT FILE APPLICATION The Recipient subsystem hold information for every person who was screened through the Long Term Care Consultation process or who applied for public programs. Much of the information in MMIS RECIPIENT FILE APPLICATION comes from the MAXIS system that financial workers use to record program financial eligibility data.
On the next page we wil learn more about the MMIS MAIN MENU.