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AME MMIS Replacement Project 1
AME PMO LOGO HERE
Overview for Arkansas Foundation for Medical Care (AFMC)
AME PMO LOGO on each slide
AME MMIS Replacement Project
AME MMIS Replacement Project 1
Version 0.1
December 7, 2016
AME MMIS Replacement Project 2
AME PMO LOGO HEREWhat 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 3
AME PMO LOGO HEREArkansas Medicaid Operations
In SFY 2015, the Medicaid Management Information System (MMIS):
Processed more than 44 million provider-submitted claims
Conducted 2,598 provider visits
Conducted 22 workshops around the state and 36 virtual training sessions
Responded to 92,889 voice calls
Responded to 90,240 automated calls
Responded to 51,998 written inquiries
Processed claims submitted by 12,055 providers
Claims submitted on behalf of more than 998,530 Arkansans
Ninety-nine percent (99%) of claims processing within 30 days
Average receipt-to-adjudication time of approximately 2.6 days
On average, provider received their payments within a week of claim adjudication
Paid $6.3 billion in benefit reimbursements (includes premium payments)
Paid for 49% of all births in Arkansas
Insures approximately 501,878 children
AME MMIS Replacement Project 4
AME PMO LOGO HEREMMIS 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 existing123456
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 5
AME PMO LOGO HEREMMIS 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 6
AME PMO LOGO HEREAME MMIS Project Schedule
AME MMIS Systems Implementation
Timeline
2014 2015 2016 2017
J F M A 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 D1. Decision Support
System
2. Pharmacy System
3. Core MMIS
4. Maintenance and Operations
We are here
Implementation May 2017
6 Months Until Implementation
AME MMIS Replacement Project 7
AME PMO LOGO HERENew Modular MMIS
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.The Core MMIS project began
on December 31, 2014. It is scheduled to go live in May, 2017, on a 29-month implementation schedule.
The MMIS consists of 3 Integrated systems:
• Data Warehouse/Fraud and Abuse System
• Pharmacy System• Core MMIS System
The Data Warehouse and Fraud and Abuse Detection (FADS) went live on February 3, 2015, on time and on budget (12 Months)
AME MMIS Replacement Project 8
AME PMO LOGO HEREBenefits 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 9
AME PMO LOGO HERE
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)
View and print Remittance Advices (RA)
Electronic Prior Authorization (PA) requests and
status checks
Electronic uploads of attachments to claims and
PAs
Verify beneficiary eligibility and benefits in real
time
The new Provider Portal will Feature:
Benefits of a New Provider Portal
AME MMIS Replacement Project 10
AME PMO LOGO HEREProvider Upcoming Events
Provider Implementation Timeline Dec2016
Jan 2017
Feb 2017
Mar 2017
Apr 2017
May 2017
Jun 2017
Jul 2017
Watch for communications on projectupdates, 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 2017
AME MMIS Replacement Project 11
AME PMO LOGO HEREWhat 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 (www.medicaid.state.ar.us)
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 2017
Know who to Contact
• For Questions - contact the HPE Provider Assistance Center at [email protected]• Open Monday - Friday (8 a.m. –5 p.m.)
AME MMIS Replacement Project 12
AME PMO LOGO HERE
Project status: Roger Patton, AME PMO Deputy [email protected]
Technical questions: [email protected]
User information & training:
– Simply click the Front Line link on the Arkansas Medicaid website www.medicaid.state.ar.us
