Ditching MMIS full-system procurement for a “services-only” approach: A quick “how-to” on administrative operations

Adopting a service-based Medicaid Management Information System (MMIS) approach may require that you reorganize some of your administrative operations. For example, you’re probably using your MMIS for capitation payments and the collection of encounter data — but you don’t have to. You can make capitation payments through your finance system and feed your encounter data directly into your data warehouse, where your critical analytics and reporting take place. By stripping down your MMIS to its original function — fee-for-service claims processing — you can outsource to a much simpler, less expensive platform.

To ease the transition from one contractor to another, use a date-of-service cut-over. This eliminates the need for a complicated, expensive recoding of benefit plan changes from past years. By overlapping the two providers for six months, most claims from prior periods will go through, and the new provider will pick up the claims arriving after that time.

To learn more about making the switch to a services-only MMIS, download our white paper on modern-day alternatives to MMIS procurement practices.

Leave a Reply