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New Medicaid Management Information System

The Division of Medical Assistance Programs (DMAP) implemented a new Medicaid Management Information System (MMIS) on December 9th, 2008. The new MMIS affects all providers who are contracted with ODS to serve Oregon Health Plan (OHP) members.

What changes with the new MMIS?

OHP members will receive a wallet-sized card listing their name and ID number. It is issued at the time the member enrolls 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?

Due to the change in the ID card, eligibility will need to be verified for each patient being seen. DMAP provides two free services to verify eligibility:

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

General information for MMIS:

http://www.oregon.gov/DHS/healthplan/mmis.shtml

Training for MMIS:

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 will 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.

Lost your PIN? 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 Department of Human Services (DHS) and click on the eSubscribe link. 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 a medical carrier is chosen by the member once enrolled. 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 the patient 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 will also still be available to answer your questions on eligibility.