AME MMIS Replacement Project

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1 AME AME PMO PMO LOGO LOGO on each slide AME MMIS Replacement Project Overview for Arkansas Foundation for Medical Care (AFMC) Version 0.1 December 7, 2016 AME MMIS Replacement Project 1

2 What is the MMIS? Processes all Medicaid Claims Includes Pharmacy Point of Sale Provides Medicaid Data for Program Management, Research, and Care planning Contains Fraud and Abuse Detection Functionality Maintains the State s Compliance with Federal Regulations regarding Medicaid Supports Federal Reporting to receive Federal Financial Participation (FFP) AME MMIS Replacement Project 2

3 Arkansas Medicaid Operations In SFY 2015, the Medicaid Management Information System (MMIS): Processed more than 44 million provider-submitted claims Paid $6.3 billion in benefit reimbursements (includes premium payments) Processed claims submitted by 12,055 providers Claims submitted on behalf of more than 998,530 Arkansans Insures approximately 501,878 children Paid for 49% of all births in Arkansas Ninety-nine percent (99%) of claims processing within 30 days Average receipt-to-adjudication time Conducted 2,598 provider visits of approximately 2.6 days On average, provider received their payments within a week of claim adjudication Responded to 51,998 written inquiries Responded to 92,889 voice calls Responded to 90,240 automated calls Conducted 22 workshops around the state and 36 virtual training sessions AME MMIS Replacement Project 3

4 MMIS Replacement Project History In 2009, DHS began the process of procuring a new MMIS, which included the following steps: Developing a Cost Benefit Analysis of procuring new MMIS vs enhancing existing Documenting requirements for the MMIS from the State Writing APDs for the Replacement MMIS and Obtaining approval from CMS Writing the MMIS RFPs Evaluating the RFPs and Selecting the Implementation Vendors Pharmacy, DSS, and Core MMIS Negotiating the contracts for the MMIS vendors and obtaining legislative approval AME MMIS Replacement Project 4

5 MMIS Replacement Project History In 2011, DHS proceeded with the procurement of a new MMIS and associated professional services through a multi-contract, multi-vendor approach. Based on industry response, the approach resulted in the award of four (4) contracts between 2013 and 2014 for systems and professional services, and one contract in 2013 for Independent Validation and Verification (IV&V) as follows: Independent Verification & Validation (IV&V) Awarded to Cognosante in 2013 Project Management Office (PMO) Professional Services Awarded to Cognosante in 2013 AME Decision Support System and Services (DSS) Awarded to Optum in 2014 AME Pharmacy System and Services Awarded to Magellan Medicaid Administration (MMA) in 2014 AME Core MMIS System and Services Awarded to Hewlett Packard Enterprise (HPE) in 2014 AME MMIS Replacement Project 5

6 AME MMIS Project Schedule AME MMIS Systems Implementation Timeline 1. Decision Support System 2. Pharmacy System J F MA M J J A S O N D J F MA M J J A S O N D J F MA M J J A S O N D J F MA M J J A S O N D 3. Core MMIS 4. Maintenance and Operations 6 Months Until Implementation We are here Implementation May AME MMIS Replacement Project 6

7 New Modular MMIS The Data Warehouse and Fraud and Abuse Detection (FADS) went live on February 3, 2015, on time and on budget (12 Months) The MMIS consists of 3 Integrated systems: Data Warehouse/Fraud and Abuse System Pharmacy System Core MMIS System The Core MMIS project began on December 31, It is scheduled to go live in May,, on a 29-month implementation schedule. The Pharmacy system went live on March 14, 2015, on time and on budget. The RFP allowed for a 15 month implementation; the system was implemented in 12 months. AME MMIS Replacement Project 7

8 Benefits of a New MMIS for DHS Manpower Efficiencies Provider Efficiencies Enhanced Member Experience Policy Changes are implemented quickly System closely aligned with Federal Guidelines Proven, low-risk technology Claims are processed in real time Administrative Benefits achieved Long-Term Cost Savings for DHS Positioned for the future AME MMIS Replacement Project 8

9 Benefits of a New Provider Portal The new Provider Portal will Feature: Online provider enrollment application including electronic documentation submission Real time claims processing Real time ability to submit, view status, and adjust/void claims (including attachments) Electronic Prior Authorization (PA) requests and status checks Electronic uploads of attachments to claims and PAs Verify beneficiary eligibility and benefits in real time View and print Remittance Advices (RA) AME MMIS Replacement Project 9

10 Provider Upcoming Events Provider Implementation Timeline Dec 2016 Jan Feb Mar Apr May Jun Jul Watch for communications on project updates, portal registration and training opportunities in your area Prepare your EDI Clearing House for connectivity testing Register for training Register for new web portal Attend Training Implementation May AME MMIS Replacement Project 10

11 What to do to Prepare Check Your Mail Be on the lookout for our newsletter, ArkMedicaid Insider, to stay informed on the progress of the new MMIS, training, and web portal registration. Additional mailers include Remittance Advice (RA) Stuffers & Post Cards Online Support Visit our new webpage called Front Line for information about the progress of the new system s development and delivery. Simply click the Front Line link on the Arkansas Medicaid website ( Share Information Inform your staff on the changes and upcoming training Check-in with your EDI Clearing House or Submitter to make sure they are aware they will need to perform connectivity testing Training Check the ArkMedicaid Insider and Front Line webpage for training dates and locations in your area. Attend training so you are ready to interact with the new Healthcare portal when we Go-live May Know who to Contact For Questions - contact the HPE Provider Assistance Center at arxixnewsystem@hpe.com Open Monday - Friday (8 a.m. 5 p.m.) AME MMIS Replacement Project 11

12 Project status: Roger Patton, AME PMO Deputy Director Technical questions: User information & training: Simply click the Front Line link on the Arkansas Medicaid website AME MMIS Replacement Project 12

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