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Idaho Medicaid MMIS Replacement Project

In 2010 Idaho Medicaid will replace its Medicaid claims processing system which is currently supported by EDS.  The new system is a Medicaid Management Information System referred to as Idaho MMIS.  The new system will be supported by Unisys Corporation, First Health Services and Thomson Reuters. 

Idaho MMIS will go live using a phased implementation with First Health Services going live in Februrary of 2010 and Unisys Corporation going live in the spring/summer of 2010.

Unisys will provide the Base component of the MMIS, which will receive and process prior authorizations, referrals, claims, and remittance advices for medical and dental services. Unisys will also manage provider enrollment for all Idaho Medicaid providers.  Unisys will provide day-to-day operational support for providers, including coordination of training and communication.  Unisys will also station Provider Regional Consultant staff throughout the state to assist providers. 

First Health Services will provide the new Pharmacy Benefits Management (PBM) portion of the MMIS and is scheduled to go live February 2010.  First Health will receive and process drug prior authorizations, adjudicate drug claims, and produce remittance advices for drug claims.  First Health Services will provide technical call center support to pharmacy providers. 
 
Thomson Reuters will provide the Decision Support System (DSS) which Idaho will use for analytics and reporting. 
 
If you have questions, MMIS specialists are available to answer your questions by email at IdahoMMIS@dhw.idaho.gov.

 

 

 

 

 

 
Announcements

Provider Record Update is Underway

Provider Record Update is the process where you will review, verify and update your provider record in the new system.
 
Who Must Complete Provider Record Update?
 
Providers who wish to submit claims to and receive payment from Idaho Medicaid must complete the record update process.
 
Provider Record Update Registration
 
Provider Record Update Registration is available. The registration form, instructions and schedule are located just to the right of this message under resources. If you experience difficulties call (866) 686-4272 for assistance. 

Attention Pharmacy Providers and PES Users 

  1. Do you use the Provider Electronic Solutions (PES) software provided by EDS to submit claims or verify eligibility?
  2. Do you submit claims SOLELY on paper?
If you answererd yes to either of these questions, please send an email with "PES" in the subject line to IdahoMMIS@dhw.idaho.gov immediately.  These processes will change in early spring of 2010 and we need to discuss the options that will be available to you.

HIPAA Companion Guides

HIPAA Companion Guides for electronic transactions are posted just to the right of this message under Technical Resources.  If you have questions, please contact the Unisys EDI Helpdesk at (866) 686-4272 and ask for technical support or email Unisys at idtechnicalservices@Unisys.com.

Provider Record Update (PRU) Letter 1 Has Been Mailed

The first of two PRU letters have been mailed to Providers.  This letter has been posted just to the right of this message under General Resources.  If you have questions, please call (866) 686-4272 for assistance. 
 

 

 

 

 
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