MCMIS-- definition

MCMIS-- managed care management information system, an automated information system designed and maintained to integrate information across the enterprise. The State recommends that the system include, but not necessarily be limited to, the following functions: - Provider Services - Claims and Encounter Processing - Prior Authorization, Referral and Utilization Management - Financial Processing - Quality Assurance - Management and Administrative Reporting - Encounter Data Reporting to the State MEDICAID--the joint federal/State program of medical assistance established by Title XIX of the Social Security Act, 42 U.S.C. Section 1396 et seq., which in New Jersey is administered by DMAHS in DHS pursuant to N.J.S.A. 30:4D-1 et seq. MEDICAID ELIGIBLE--an individual eligible to receive services under the New Jersey Medicaid program. MEDICAID EXPANSION--means the expansion of the New Jersey Care...Special Medicaid Programs, incorporates NJ FamilyCare Plan A, that will extend coverage to uninsured children below the age of 19 years with family incomes up to and including 133 percent of the federal poverty level. (See NJ FamilyCare Plan A) MEDICAID RECIPIENT OR MEDICAID BENEFICIARY--an individual eligible for Medicaid who has applied for and been granted Medicaid benefits by DMAHS, generally through a CWA or Social Security District Office. MEDICAL COMMUNICATION--any communication made by a health care provider with a patient of the health care provider (or, where applicable, an authorized person) with respect to:

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Examples of MCMIS-- in a sentence

• This information shall be accessible to all parts of the MCMIS for editing and reporting.

• The MCMIS shall accommodate the following specific Medicaid/NJ FamilyCare requirements.

• MCMIS reporting capabilities shall include the capabilities to access relatively small amounts of data very quickly as well as to generate comprehensive reports using multiple years of historical claims and encounter data.

• The prior authorization/referral and utilization management functions shall be an integrated component of the MCMIS.

• The contractor shall be responsible for the provision of necessary information and records, whether a part of the MCMIS or compiled and/or stored elsewhere, to the new contractor and/or DMAHS during the closeout period to ensure a smooth transition of responsibility.

• The Contractor’s MCMIS shall also be a collection point and repository for all data required under this contract and shall provide comprehensive information retrieval capabilities.

• The Contractor shall provide a management and administrative reporting system that allows full access to all of the information utilized in the MCMIS.

• The Contractor’s Managed Care Management Information System (MCMIS) shall provide certain minimum functional capabilities as described in this contract.

• The MCMIS should provide flexible report formatting/editing capabilities that meet the Contractor’s business requirements and support the Department’s information needs.

• The system(s) shall provide secure online access for Contractor use to all major files and data elements within the MCMIS including enrollee demographic and enrollment information, provider demographic and enrollment data, processed claims and encounters, prior approvals, plans of care and MLTSS electronic Care Management records, referrals, reference files, and payment and financial transactions.