Medicaid Management Information System. (MMIS) - The medical assistance and payment information system of the Michigan Department of Health and Human Services (Community Health Automated Medicaid Processing System - CHAMPS)
Medicaid Management Information System. (MMIS) – an integrated group of subsystems used for the processing, collecting, analysis, and reporting of information needed to support Medicaid and Children's Health Insurance Program (CHIP) functions including claims and payments. Medicaid Policy – collectively refers to documents and other written materials including the State Medicaid plan, program instructions, attendant provider manuals, program bulletins, and all published policy decisions issued by BMS. These materials are available through BMS. Medicaid Program Provider Manuals – service-specific documents created by the Bureau for Medical Services to describe policies and procedures applicable to the program generally and that service specifically. Medical Assessment – an initial medical evaluation completed for enrollees in Xxxxxx Care when they have newly entered or are re-entering Xxxxxx Care. The Medical Assessment must follow the requirements set forth in Medicaid EPSDT program, and include dental, hearing, and developmental screenings. A trauma assessment must also be performed at this time. Assessments must be completed within thirty (30) calendar days. Medical Loss Ratio (MLR) – the ratio of the numerator (as defined in accordance with 42 CFR 438.8(e)) to the denominator (as defined in accordance with 42 CFR 438.8(f)) and subject to any applicable adjustments, as provided under this Contract and Appendix G. Medically Necessary – refers to services or supplies for diagnosing, evaluating, treating, or preventing an injury, illness, condition, or disease, based on evidence-based clinical standards of care. Medically necessary services are accepted health care services and supplies provided by health care entities, appropriate to evaluation and treatment of a disease, condition, illness or injury and consistent with the applicable standard of care. Determination of medical necessity is based on specific criteria. For Medicaid covered medical or other health services to children under twenty-one (21) it refers to services which: a) are reasonable and necessary to prevent illness or medical conditions, or provide early screening, interventions, and/or treatment for conditions that cause suffering or pain, cause physical deformity, or limitation in function, cause illness or infirmity, endanger life, or worsen disability; b) are provided at appropriate facilities and at the appropriate levels of care for the treatment of a member’s medical conditions; c) are consistent with the diagnosis of the...
Medicaid Management Information System. (MMIS) - an integrated group of subsystems used for the processing, collecting, analysis, and reporting of information needed to support Medicaid and CHIP functions including claims and payments. Medicaid Policy – collectively refers to documents and other written materials including the State Medicaid plan, program instructions, attendant provider manuals, program bulletins, and all published policy decisions issued by BMS. These materials are available through BMS. Medicaid Program Provider Manuals – service-specific documents created by the Bureau for Medical Services to describe policies and procedures applicable to the program generally and that service specifically. Medical Assessment - An initial medical evaluation completed for members in Xxxxxx Care when they have newly entered or are re-entering Xxxxxx Care. The Medical Assessment must follow the requirements set forth in Medicaid EPSDT program, and include dental, hearing, and developmental screenings. A trauma assessment must also be performed at this time. Assessments must be completed within thirty (30) calendar days. Medical Loss Ratio (MLR) - the ratio of the sum of total medical expenses and the total capitation revenue, including monthly capitation and delivery kick payments, received by the MCO and subject to any applicable adjustments, as provided under this Contract and Appendix H. Medically Necessary – refers to items or services furnished or to be furnished to a patient for diagnosing, evaluating, treating, or preventing an injury, illness, condition, or disease, based on evidence-based clinical standards of care. Medically necessary services are accepted health care services and supplies that are reasonable and necessary for the diagnosis or treatment of illness or injury; to improve the functioning of a malformed body member; to attain, maintain, or regain functional capacity; for the prevention of illness; or to achieve age-appropriate growth and development. Determination of medical necessity is based on specific criteria. Mountain Health Trust (MHT) – the name of West Virginia’s Medicaid mandatory managed care program for TANF and TANF-related children and adults who are eligible to participate in managed care.
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.
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. Medicaid Recipient Fraud Unit (MRFU) – The division of the State Attorney General’s Office that is responsible for the investigation and prosecution of Recipient fraud.
Medicaid Management Information System. (MMIS) - The medical assistance and payment information system of the Virginia Department of Medical Assistance Services.
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. Medicaid Waiver - Generally, a waiver of existing law authorized under Section 1115(a), or 1915 of the Social Security Act. Medically Necessary or Medical Necessity – Services shall be provided consistent with all Enrollee protections and benefits provided by Medicare and MassHealth, and that provide the Enrollee with coverage to at least the same extent, and with the cumulative effect, as provided by the combination of Medicare and MassHealth. Per Medicare, Medically Necessary Services are those that are 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. § 1395y. In accordance with Medicaid law and regulations, services shall be provided in accordance with MassHealth regulations, including in accordance with 130 CMR 450.204. Medically Necessary services are those services: That are reasonably calculated to prevent, diagnose, prevent the worsening of, alleviate, correct, or cure conditions in the Enrollee that endanger life, cause suffering or pain, cause physical deformity or malfunction, threaten to cause or to aggravate a disability, or result in illness or infirmity; and For which there is no other medical service or site of service, comparable in effect, available, and suitable for the Enrollee requesting the service that is more conservative or less costly. Medically Necessary services shall be of a quality that meets professionally recognized standards of health care and shall be substantiated by records including evidence of such medical necessity and quality. In addition, a service is Medically Necessary when: It may attain, maintain, regain, improve, extend, or expand the Enrollee’s health, function, functional capacity, overall capacity, or otherwise support the Enrollee’s ability to do so; or A delay, inaction, or a reduction in amount, duration, or scope, or type or frequency of a service may jeopardize the Enrollee’s health, life, function, functional capacity, or overall capacity to maintain or improve health or function. Medicare - Title XVIII of the Social Security Act, the federal health insurance program for people aged 65 or older, people under 65 with certain disabilities, and people wit...
Medicaid Management Information System. (MMIS) - The medical assistance and payment information system of the Rhode Island Executive Office of Health and Human Services.
