CLAIMS PROCESSING APPLICATIONS
The CLAIMS PROCESSING subsystem is the heart of MMIS. Every other subsystem interacts in some way with the claims processing subsystem.
Using the data contained in the most current recipient master file, provider master file, and reference files the CLAIMS PROCESSING subsystem edits, audits, and processes claims to final disposition according to the policies and procedures established by the Department of Human Services (DHS) in adherence with state and federal rules and regulations.
Each month, MMIS processes between two and three million claims. Legislation mandates that claims are to be paid within 90 days of submittal. State-imposed time limit for processing simple claims (those with no attachments) is 30 days. The underlying communication, routing and adjudication systems must therefore run smoothly and without interruption.
As of 07/15/09 all claims for Minnesota Health Care Programs must be submitted electronically through MN-ITS or pharmacy POS. MN-ITS is the DHS billing system for Minnesota Health Care Programs (MHCP) claims and other transactions. Information entered in MN-ITS is interfaced into MMIS.
A detailed review of all claims processing functions is not within the scope of this course. However leaning to navigate to view claims in MMIS is. So let's learn about navigating INQUIRY in the CLAIMS PROCESSING subsystem now.