Fiscal Agent Project/MIHMS

Work is underway to build a new Medicaid Management Information System called the Maine Integrated Health Management Solution (MIHMS)

Nearly 300,000 of Maine’s most vulnerable citizens rely on DHHS and MaineCare for health care services. MaineCare is working to improve operations so more focus can be given to the health of these citizens. In addition, we want to make MaineCare a best-practice Medicaid plan. For these reasons, work is underway to transition the MaineCare program to a fiscal agent model of operations.

A fiscal agent is a vendor that develops a Medicaid Management Information System (MMIS, otherwise known as the claims processing system) and operates certain services on behalf of the State. Fiscal agents are already in use in 37 states.

Unisys was selected last year as the MaineCare fiscal agent vendor. Implementation of the new claims processing system is anticipated in early 2010. The Unisys “HealthPAS” solution is COTS-based. It is a processing system joining several commercially-available applications and is in use by other Medicaid programs. So the MaineCare project will be an adaptation of an existing, CMS-certified system.

In addition to helping MaineCare implement a new claims processing system, Unisys will also operate some MaineCare functions. A series of related business initiative projects are also underway. The business initiatives include:

• work to become HIPAA compliant and eliminate local codes
• an accelerated provider re-enrollment and use of NPI
• examination of options for more consistent and useful pricing structures for long-term care facilities
• review of member rates
• design of member benefit packages

This site will continually be updated and expanded with new information from the implementation of the new MMIS and fiscal agent vendor.

MIHMS Provider Forums

MIHMS provider forums began in November 2008. Presentations from the forums held to date are listed below.

Design Work Underway

The State and Unisys teams are currently working to design the new claims processing system. The first design document is related to Phase 1, the Provider Re-enrollment. This detailed design document is currently being reviewed by the State.

Phase 1: Provider Re-enrollment and NPI Acceptance

The first phase of implementation for the new claims management system will be provider re-enrollment. This will take place in three stages, beginning in June 2009.