The Division of Medical Assistance Programs (DMAP) implemented a new Medicaid Management Information System (MMIS) on December 9th, 2008. The new MMIS affects all providers who are contracted with Moda Health to serve Oregon Health Plan (OHP) members.
OHP members will receive a wallet-sized card listing their name and ID number. It is issued at the time the member enrolls in the Oregon Health Plan. The MMIS gives providers free, real-time access to eligibility verification 24 hours a day, seven days a week. It provides eligibility by specific date, insurance carrier and benefit package.
Due to the change in the ID card, eligibility will need to be verified for each patient being seen. DMAP provides two free services to verify eligibility:
http://www.oregon.gov/DHS/healthplan/mmis.shtml
DMAP provides a number of training opportunities for the MMIS.
Both the Provider Web Portal and the AVR system will require PIN numbers issued by DMAP. In November 2008, all providers with an active Medicaid provider number should have received a PIN letter for each system.
Contact DMAP Provider Services at 800-336-6016 for assistance. You will need your Medicaid provider number when you call.
Visit Department of Human Services (DHS) and click on the eSubscribe link. You can sign up to automatically receive DHS eSubscribe updates related to the MMIS system.
Eligibility requirements for all OHP members are reviewed and granted by DHS, and a medical carrier is chosen by the member once enrolled. It is the responsibility of the provider to verify that the individual receiving medical services is an eligible individual on the date of service for the service provided and that Moda Health is the managed care plan responsible for reimbursement. The provider assumes full financial risk of serving a person not confirmed by DMAP as eligible for the service provided on the date of service. (OAR 410-120-1140)
Moda Health recommends that the provider always make a photocopy of the Medical ID card and review photo identification for the patient each time they present for services.
When certain changes are made to a case, such as a change in the household or a change in prepaid health plan (PHP) enrollment, the MMIS automatically issues a new Medical ID card. The MMIS does not automatically send a new Medical ID for every action taken on a case.
Moda Health Benefit Tracker and OHP customer service representatives will also still be available to answer your questions on eligibility.
If you can't find an answer, please feel free to contact our Customer Service Customer Service Customer Service
If you can't find an answer, please feel free to contact our Customer Service
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Moda comes from the latin term "modus" and means "a way". We picked it because that's what we are here to do: help our communities find a way to better health.
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