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MMIS eligibility system and training

The Medicaid Management Information System (MMIS), implemented by the Division of Medical Assistance Programs (DMAP), affects all providers who are contracted with ODS to serve Oregon Health Plan (OHP) members. All members receive a wallet-sized card listing their name and ID number when they enroll in the Oregon Health Plan. The MMIS gives providers free, real-time access to eligibility verification 24 hours a day, seven days a week. It provides eligibility by specific date, insurance carrier and benefit package.

How do you verify OHP patient eligibility?

Eligibility must be verified for each patient you see. DMAP provides two free services to help you verify eligibility:

The Provider Web Portal
The Automated Voice Response (AVR): 866-692-3864

Where can you get more information about MMIS?

General information for MMIS can be found online, and DMAP provides a number of training opportunities for the MMIS.

How do you obtain access to the MMIS?

Both the Provider Web Portal and the AVR system require PIN numbers issued by DMAP. In November 2008, all providers with an active Medicaid provider number should have received a PIN letter for each system.

What if you lose your PIN or need to reset your password?

Contact DMAP Provider Services at 800-336-6016 for assistance. You will need your Medicaid provider number when you call.

Have you e-subscribed?

Visit the Department of Human Services (DHS). You can sign up to automatically receive DHS eSubscribe updates related to the MMIS system.

Important information about eligibility verification

Eligibility requirements for all OHP members are reviewed and granted by DHS, and members choose a medical carrier after enrollment. It is the responsibility of the provider to verify that the individual receiving medical services is an eligible individual on the date of service for the service provided and that ODS is the managed care plan responsible for reimbursement. The provider assumes full financial risk of serving a person not confirmed by DMAP as eligible for the service provided on the date of service. (OAR 410-120-1140)

ODS recommends that the provider always make a photocopy of the Medical ID card and review photo identification for patients each time they present for services.

When certain changes are made to a case, such as a change in the household or a change in prepaid health plan (PHP) enrollment, the MMIS automatically issues a new Medical ID card. The MMIS does not automatically send a new Medical ID for every action taken on a case.

ODS Benefit Tracker and OHP Customer Service representatives also are available to answer your questions on eligibility.