Maine Integrated Health Management System (MIHMS)
By Loretta Wells, DHHS
MaineCare has been working with the Department of Health and Human Services fiscal agent, Unisys, to design and implement a new Medicaid claims processing system, known as the Maine Integrated Health Management Solution (MIHMS). This system is scheduled to be fully implemented in spring 2010.
The project consists of two phases. Phase One requires the full re-enrollment of all Providers. Re-enrollment will allow the State to capture National Provider Identifier (NPI) information to comply with federal requirements, as well as minimize data conversion errors in the provider file of the new solution. Additionally, this phase includes implementing the use of Health Insurance Portability and Accountability Act (HIPAA)-compliant 837 electronic claims transactions prior to the full implementation of MIHMS. The Phase One portion of the project is scheduled to be completed in early part of 2010.
Phase Two consists of the electronic claims transaction, prior authorization, third party liability, program integrity and care management functions, as well as the Data Warehouse and Decision Support System. This functionality is scheduled to be available in spring 2010. Currently, system functionality testing is occurring to prepare for full implementation.
When the new system is fully implemented, providers will have the ability to:
- Verify member eligibility
- View payment history
- Submit X12 transactions
- Update Provider Information
- Direct Data Enter and adjudicate Claims
- Submit Referrals and Prior Authorizations requests
- Create member rosters
Members will have the ability to:
- Request a duplicate Identification Card
- Request a certificate of creditable coverage
- Look-up doctors
- Access Community Resources Links
The Cutover Strategy: Moving from MeCMS (the current system) to MIHMS
The goal is to maintain core MaineCare Services claims operation and minimize risk in implementing the new claims processing system. As a result, MIHMS will use a “Date of Service” cutover strategy, widely used today in the commercial payer environment when implementing new billing and claims processing systems.
Additionally, MaineCare will maintain MeCMS for a period of six months post the implementation of MIHMS, as approved by Centers for Medicare and Medicaid (CMS). MeCMS will be only process claims with DOS that occur prior to MIHMS Implementation.
If you have questions regarding MIHMS Implementation Project please e-mail: MaineCare2010.DHHS@maine.gov