Assessing Replacement MMIS

North Carolina’s Department of Health and Human Services (DHHS requested that an independent assessment be done by Susan D. Young, a Charlotte-based IT consultant to gauge the readiness of the state’s Medicaid Management Information System (MMIS). The assessment was conducted between January 7, 2013 and February 1, 2013 and showed that the new MMIS system scheduled to live July 1, still has some critical challenges.

The new MMIS will replace a 35 year old computer system that processes 88 million state Medicaid claims each year on behalf of 1.5 million Medicaid recipients and issues checks to 70,000 providers totaling more than $11 billion.

The consultant found that the biggest risk centered on communication. According to Young, “The MMIS is a large and complex system with a lot of players involved so making sure that providers and key stakeholders across an entire organization know how to use the new system properly will be very important in making the transition successful.”

Young identified two other key risks such as dealing with the testing schedule to be made tighter by critical system changes that include restructuring the Medicaid personal care services and converting the Local Management Entities to Managed Care Organizations. Another matter that needs to be addressed is to ensure that all business processes are accounted for including those processes that will not be incorporated into MMIS immediately and will require a temporary workaround procedure.

Joseph Cooper Jr., the new CIO for DHHS said, “The Department is using Young’s assessment to take proactive steps to mitigate top-level risks and system-level flaws that have been identified in earlier testing. The department is actively pursuing ways to communicate effectively with our partners to ensure that there is little to no interruption in services or payments.”

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