Medicaid Enterprise Systems – Provider Services Module The Portfolio Action Tracker (PAT) is a transparency tool that can be used to monitor and review the real-time status of NASPO ValuePoint portfolios. Click here to view Status

A Medicaid Management Information System (also known as “MMIS”) is a mechanized claims processing and information retrieval system that all states are required to have according to section 1903(a)(3) of the Social Security Act defined in Federal Code 42 CFR 433.111. 

The Provider Services module will support provider enrollment, re-validation, and maintenance. The Provider Services vendor will provide a configurable, web based, self-service solution that allows healthcare providers to enroll electronically with Healthcare Programs and provide an option for provider self-service updates.  

Below are some highlights of the benefits from the prospective contract awards:

1.  Modern Provider Enrollment system that is highly configurable, web based, and automates many of the manual functions occurring in the legacy MMIS (e.g., automated workflows, automatically triggered communication based on key elements within the provider’s enrollment record).

2.  User centric Provider Management module that includes a number self-service features not currently available today to improve customer interaction with the State’s Medicaid Agency.

3.  Provider Services solution that is configured “out of the box” to be compliant with current Federal Regulations