According to the Iowa Medicaid Enterprise (IME) newsletter “Endeavors Update”, the state is planning to procure a new Medicaid Management Information System (MMIS) early next year. Iowa Medicaid is the second largest healthcare payer in Iowa and is expected to serve 21 percent of the population in the state in FY 2012.
The current system is using a 1970s era mainframe, processing over 23 million medical claims for 656,000 Iowans, has a total budget of approximately $4.2 billion, supports services to 38,000 active healthcare providers, supports claims processing, provider network management, managed care operations, plus other functions.
The benefits of a new system would provide for:
• Real-time claim adjudication for providers so that they will be able to get immediate feedback on coverage
• Auditable claims so that every rule applied to the claim can be identified
• Expanded functionality of the providers website portals so that paperwork would be reduced
• Access to wellness information, personalized alerts, and reminders
• Improved security, better data, modeling and program integrity
• Rapid implementation of programs and decisions
The new MMIS will enable the state to be better positioned to meet and implement the state HIE requirements and to meet other federal mandates. As part of the procurement process, the Department of Health Services plans to release a draft version of the RFP for MMIS early next year for vendor review and comment. Also an Industry Day will be held at that time so that MMIS vendors will be able to interact with IME and discuss the intended procurement.
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