About MMIS

Page posted: 8/3/26

The Medicaid Management Information System (MMIS) is a mainframe system designed to:

· Process health services claims.

· Detect and reduce fraud and abuse.

· Provide information for policy development, administrative decisions and reporting.

MMIS is the largest public health care payment system in Minnesota. It stores three years of online billing and claims payment history. DHS implemented the current MMIS system software in June 1994.

MMIS is the system of record for provider enrollment, service authorization, third-party liability and payment data. The federal government reimburses DHS at a rate of 75 to 90% of the cost of MMIS operations, maintenance and development.

Features

The system has the following features:

· Health Insurance Portability and Accountability Act (HIPAA)-compliant, standard national billing formats to increase uniformity with other Minnesota health care payers.

· Web-based system called MN–ITS that providers use to determine people’s eligibility, submit claims, obtain claim status and get free remittance advice. More than 99% of Minnesota Health Care Programs (MHCP) non-pharmacy, fee-for-service claims are submitted electronically via MN–ITS.

· Phone-based, batch and real-time eligibility verification systems (EVS).

· Pharmacy point-of-sale system for prompt electronic processing of 99.9% of all drug claims.

· Nightly data downloads into the DHS data warehouse to incorporate and integrate assessment, service authorization, claims and payment information into DHS for reports and decision-making.

· Interface capabilities with METS, MAXIS, PRISM and the Social Service Information System (SSIS).

Interface with MAXIS

Eligibility workers (also called financial workers) use MAXIS to determine, document and maintain a person’s eligibility for health care and other programs.

MMIS interfaces with MAXIS through the recipient subsystem. The recipient subsystem collects information from MAXIS about a person’s demographic and health care program eligibility determination.

Some information in MAXIS automatically transfers to MMIS. Data produced in MAXIS can only be changed in MAXIS. If an MMIS worker notices incorrect information provided by MAXIS, they must ask the eligibility worker to correct the information in MAXIS. Then, the change transfers to MMIS.

MAXIS security and access are separate from security and access to MMIS. For more information about MAXIS, refer to PartnerLink – MAXIS.

PMIN function

MAXIS assigns an ID number to each person applying for most programs. This number is called the person master index (PMI) number. It is a unique, eight-digit number that identifies the person in the system. The person’s PMI number never changes, even when they change programs, lose eligibility or move to another lead agency.

If a person is assigned more than one PMI number, DHS and the financial worker make one of the numbers inactive.

Lead agency staff use the PMIN function of MAXIS to assign the person’s PMI number when an eligibility worker is not involved in the person’s case and/or the person has not been previously assigned a PMI number. This includes people who:

· Receive a preadmission screening (PAS).

· Receive services through the Alternative Care (AC), Essential Community Supports (ECS) or MinnesotaCare programs.

If you have access to use the PMIN function, you can use it to make some MAXIS changes without an eligibility worker, including changes to birth date, marital status, name, etc. Then, the changes transfer to MMIS.

Subsystems

MMIS includes integrated subsystems that process health care claims payments to providers and managed care capitation payments to DHS-contracted managed care organizations.

For more information about subsystems, refer to MMIS LTSS Manual – MMIS subsystems.

Resources

MMIS LTSS Manual – Access to MMIS
MMIS LTSS Manual – Basic actions and common errors
MMIS LTSS Manual – Function keys
MMIS LTSS Manual – Get to know MMIS
MMIS LTSS Manual – MMIS subsystems
PartnerLink – MAXIS