What you can do now

This page outlines the major changes you will see as DHS prepares to implement the replacement MMIS later this year, and what you can do to prepare for the change. Above all, keep informed by reading all MMIS communications you receive from DHS. You can also eSubscribe to receive an e-mail alert  each time the MMIS Provider Resources Web site is updated.

• Electronic Data Interchange (EDI) testing
• Electronic Funds Transfer (EFT)
• Eligibility verification and PIN letters
• National Provider Identifier (NPI)
• Provider Web Portal
• Standardized paper claims

For information on the benefits and changes for pharmacy providers, go to the Pharmacy Benefit Management section of the MMIS Provider Resources site.

For information on the benefits and changes for managed care organizations, go to the Managed Care Information section of the MMIS Provider Resources site.

For information on the benefits and changes related to electronic data interchange, go to the EDI page of the site.

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Electronic Data Interchange (EDI) testing

Once the replacement MMIS goes live, DHS will only continue exchanging EDI transactions with submitters who successfully test their HIPAA-compliant transactions in the new MMIS server. This includes submitting 837 claim transactions, 270/271 eligibility verification transactions, and using the new 278 EDI transaction for prior authorization (PA).

• If you are a current EDI submitter, make sure to complete testing with DHS before the go-live date. For more information about what to do to prepare for testing, go to the MMIS EDI Web page.
• If you are not a current EDI submitter but want to become one, go to the DHS EDI Registration and Testing Web site.

Once the replacement MMIS goes live, DHS will no longer support non-HIPAA claims transactions. DHS will only continue exchanging EDI transactions with those EDI submitters who re-tested and recertified as indicated above. This includes submitting 837 claim transactions, 270/271 eligibility verification transactions, and using the new 278 EDI transaction for prior authorization (PA).

• If you are interested in electronically submitting claims, PA requests, claims status requests, and/or eligibility verification requests, you must become an approved EDI submitter. To learn more, go to the DHS EDI Registration and Testing Web site.

Electronic Funds Transfer (EFT)

All providers who currently receive their claims payments via EFT (direct deposit) will have their EFT information automatically converted into the replacement MMIS system so that their electronic payments will continue after implementation.

• Any enrolled DMAP provider can sign up now for EFT/direct deposit. For more information on how to apply for EFT, click here.
• Providers who do not have the option of EFT in the current system will have this payment option when the replacement MMIS goes live.

Eligibility Verification and PIN letters

The replacement MMIS will provide a one-time, wallet-sized Medical Care ID card that will replace the current 8.5 x 11 ID card. The Medical ID is not a guarantee of eligibility, and the new wallet-sized ID will not provide eligibility information on the card.

• Before providing services, providers must continue to verify the client's eligibility to confirm that the client receiving services is, in fact, an eligible individual on the date of service. Date of service is defined as the date services are rendered.
• Make sure DHS has your current mailing address so that you will receive the Personal Identification Number (PIN) letters for the AVR and Provider Web Portal when DHS sends them two weeks before the MMIS go-live date. Complete the Provider Information Update form (PDF) and send it to DMAP today.
• If you have questions about where DHS will be mailing your PIN letter, contact DMAP Provider Enrollment at 800-422-5047 or e-mail provider.enrollment@state.or.us.
• eSubscribe to the MMIS Provider Resources Web site so that you receive an e-mail alert when DHS sends the letters.

National Provider Identifier (NPI)

The replacement MMIS will accommodate the National Provider Identifier for all eligible providers. To ensure appropriate claims processing and payment, all eligible providers must register their NPI and taxonomy code(s) with DMAP as soon as possible. New providers are also required to submit their NPI and taxonomy code(s) when enrolling with DMAP.

• If you are a current DHS provider who is eligible for NPI and haven’t submitted your NPI to DMAP, click here for more information.

Provider Web Portal

Providers will be able to submit claims, verify eligibility, check OHP diagnosis and procedure pairs, submit prior authorization (PA) requests and much more via the secure Provider Web Portal. More information about the benefits of the replacement MMIS, including Provider Web Portal benefits, can be found here.

• To use the Web portal, your computer system will need an Internet connection and compatible Internet browser. The Web portal currently supports Internet Explorer 6, Internet Explorer 7, and Mozilla Firefox 2.
• If you have support staff who do not have Internet access and you want them to perform certain functions of the Web portal, make sure you get them appropriate access.
• Make sure you are ready to use the new eligibility verification systems when the MMIS goes live! Make a list (Word) (PDF) of which staff need access to the Provider Web Portal, and for what functions, then save the list to use when the MMIS goes live.

Standardized Paper Claims

In the replacement MMIS, DHS will transition to paper claims processing on industry-standard claim forms for most claims. DHS will continue using the DMAP 1036 and DMAP 505 claim forms. If you submit paper claims on any other forms, DHS will return those claims to you with a request to resubmit them on the appropriate claim form.

If you need to start using standard claim forms, go to the DMAP Billing Tips Web page for information on how to obtain and complete the ADA, UB and CMS-1500 forms.

• Paper claims submitted on commercially available, “red form” versions of the UB-04 and CMS-1500 will directly enter the replacement MMIS using Optical Character Recognition (OCR).
• The Provider Web Portal will also allow providers to submit individual ADA, UB, CMS-1500 and Medicare-Medicaid crossover claims directly into the replacement MMIS.
• Electronic Data Interchange (EDI) claim transactions also directly enter the replacement MMIS. If you are interested in submitting claims, PA requests, claims status requests, and/or eligibility verification requests via Electronic Data Interchange, you must become an approved EDI submitter. To learn more, go to the DHS EDI Registration and Testing Web site.