Medicaid Management Information. System (MMIS) – the management information system of software, hardware and manual processes used to process claims and to retrieve and produce eligibility information, service utilization and management information for Members. Medically Necessary – in accordance with 130 CMR 450.204, Medically Necessary services are those services
Medicaid Management Information. System (MMIS) data:
Medicaid Management Information. System (MMIS) - The medical assistance and payment information system of SCDHHS. Medicaid Waiver - Generally, a waiver of existing law authorized under Section 1115(a), 1115A, or 1915 of the Social Security Act and approved by CMS for operation for a specified period of time. Medical Home - A health care setting that incorporates a physician and provides care services in a high-quality and cost-effective manner. Care is facilitated by registries, information technology, health information exchange, and other means to assure that patients receive the indicated care in an appropriate manner. The approach seeks to strengthen the patient-Provider relationship by coordinating all care, including acute, chronic, preventative, and end-of-life. Medical Homes provide care that is accessible, continuous, comprehensive, patient-centered, coordinated, compassionate, and culturally and linguistically effective. Medically Necessary or Medical Necessity - Services must be provided in a way that provides all protections to the Enrollee provided by Medicare and SC Medicaid. Per Medicare, services must be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, or otherwise Medically Necessary under 42 U.S.C. §1395(y). In accordance with Medicaid law and regulations, and per SC Medicaid, services must be those medical services which: (a) are essential to prevent, diagnose, prevent the worsening of, alleviate, correct, or cure medical conditions that endanger life, cause suffering or pain, cause physical deformity or malfunction, threaten to cause or aggravate a handicap, or result in illness or infirmity of a SC Medicaid member; (b) are provided at an appropriate facility or by an appropriate contracted Provider and at the appropriate level of care for the treatment of the SC Medicaid member's medical condition; and, (c) are provided in accordance with generally accepted standards of medical practice. Medicare — Title XVIII of the Social Security Act, the federal health insurance program for people age 65 or older, people under 65 with certain disabilities, and people with End Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis. Medicare Part A provides coverage of inpatient hospital services and services of other institutional Providers, such as skilled nursing facilities and home health agencies. Medicare Part B provides supplementary medical insurance that covers physician services, ...
Medicaid Management Information. System MMIS The MMIS is an integrated group of procedures and computer processing operations (subsystems) developed at the general design level to meet principal objectives. For Title XIX purposes, "systems mechanization" and "mechanized claims processing and information retrieval systems" is identified in section 1903(a)(3) of the Act and defined in regulation at 42 CFR 433.111. The objectives of this system and its enhancements include the Title XIX program control and administrative costs; service to recipients, providers and inquiries; operations of claims control and computer capabilities; and management reporting for planning and control. Source: xxxx://xxx.xxx.xxx/Research-Statistics-Data-and- Systems/Computer-Data-and- Systems/MMIS/index.html?redirect=/MMIS/ Medical Supplies Disposable, semi-disposable, or expendable medical supplies. This does not include durable medical equipment, oxygen, or oxygen supplies. Medically Necessary Pharmaceutical service that is consistent with the recipient's diagnosis or condition; recognized as the prevailing standard or current practice among the provider's peer groups; and rendered in response to a life- threatening condition or paint; to treat an injury, illness or infection; to treat a condition that could result in physical or mental disability; to care for a mother and child through the maternity period; or to achieve a level of physical or mental function which is consistent with prevailing community standards Medicare Health insurance program for the aged and disabled under Title XVIII of the Social Security Act. Member An individual eligible and enrolled in one or more State benefit plans. Metadata Information that describes various facets of an information asset to improve its usability throughout its life cycle. Middleware Computer software that connects software components or applications. The software consists of a set of services that allows multiple processes running on one or more machines to interact Module A portion of a system that provides specific, discrete functionality. Multi-Source Brand Drug A brand drug for which the patent has expired. National Association of Board of Pharmacies NABP Independent, international, and impartial association that assists its member boards and jurisdictions in developing, implementing, and enforcing uniform standards for the purpose of protecting the public health. xxxx://xxx.xxxx.xxx/ National Council for Prescription Drug Programs NCPDP Entity that creates a...
Medicaid Management Information. System (MMIS) - The medical assistance and payment information system of the Rhode Island Executive Office of Health and Human Services.
