Medicaid Management Information System
MMIS is the largest health care payment system in Minnesota, and one of the largest payment systems in the nation. Health care providers throughout the county – as well as DHS and county staff – use MMIS to pay the medical bills and managed care payments for over 525,000 Minnesotans enrolled in MinnesotaCare, Medical Assistance (MA), General Assistance Medical Care (GAMC) and the Alternative Care Grants Program (ACG). These public programs (collectively referred to as the Minnesota Health Care Programs, or MHCP) provide health care services to low-income families and children, low-income elderly people and individuals who have physical and/or developmental disabilities, mental illness or who are chronically ill.
Some MHCP enrollees receive care through a fee-for-service arrangement where they find their own doctor. Others receive care through one of 9 state-contracted managed care health plans.
MMIS II began operating in 1994, replacing MMIS I that had been in use since 1974.
MMIS is state-owned and operated and has 15 subsystems, more than five years of online provider billing history, and over 500 screens and 900 claim edits to ensure appropriate payment.
The DHS Health Care Operations division (HCO) ensures that MMIS is designed, maintained and operated as a federally-certified online management information system for Medicaid programs.
In fiscal year 2001, MMIS transactions total almost $4 billion to more than 35,000 health care providers. Last year, MMIS processed more than 33 million claim transactions, as follows:
MMIS processes 99 percent of all "clean" claims within 30 days of receipt, with the average claim processed within two to three days. 96 percent of all MMIS transactions are made using electronic data interchange (EDI). MMIS encourages providers to submit bills electronically, since paper-based billing costs the state more money.
Recent System Highlights
last updated October 15, 2003