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.

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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.

Current Figures

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:

  • • 19 million fee-for-service claims
  • • 14 million encounter claims (records of health care services provided by managed care organizations)
  • 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

  • • HCO sent the 2001 MMIS Provider Satisfaction Survey to MHCP providers. (Past surveys confirm that over 96% of respondents were pleased with MMIS.)
  • • HCO developed a Provider Report Card to target providers submitting over 50% of their claims with significant errors. The Report Card suggested billing corrections that would increase the speed of reimbursements for health care claims.
  • • DHS received a federal grant to develop a national model for a payment accuracy measurement system.
  • • HCO established a county data unit share DHS Data Warehouse information and reporting capabilities with county staff.
  • • HCO recruited and developed existing DHS staff with health care expertise to become MMIS system programmers.
  • • HCO enhanced MMIS scanner capabilities, enabling provider enrollment applications to be scanned into the system.
  • • HIPAA compliance efforts were rewarded with the Center for Medicare and Medicaid Services (CMS) HIPAA Hero Award.
  • • Minnesota's MMIS is preparing for HIPAA compliance by mid-2002.
  • • HCO prepared a strategic plan for 2001.
  • Outcomes

  • • The HCO Benefit Recovery section saves the state more than $70 million a year.
  • • MMIS scored the highest score in the country (99.8) on the last Federal Systems Performance Review.
  • • MMIS has a zero percent error rate for claims payment in the last Claims Processing Assessment (CPAS).

    last updated October 15, 2003

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