State Medicaid agencies face a changing climate: increasing enrollment, rising costs of health care, and requirements by the Centers for Medicare and Medicaid Services (CMS) to comply with more stringent technology standards. As a result, many state Medicaid agencies are now replacing systems that have been in place for over 30 years.

The Challenge

State Medicaid agencies must meet CMS’s seven conditions and standards in order to qualify for matching federal funds for their technology investments. Significant numbers of resources are required over extended periods of time to plan and implement a Medicaid Management Information System (MMIS) that meets the needs of the state while complying with federal requirements.

While modularity, standardization, interoperability and leveraging help to make changes easier and quicker, states generally do not have the staff required to maintain day-to-day operations while designing, developing and implementing complex program and technology mandates that today’s circumstances require.

MMIS Modernization Infographic

The Solution

Altarum has supported the Michigan Department of Community Health and Department of Management, Technology and Budget since passage of the Health Insurance Portability and Accountability Act (HIPAA) of 2000. Our health care and technology experts have supported numerous key initiatives:

  • HIPAA standard X12 4010 A1 and NCPDP health care transactions, including medical and behavioral health encounters
  • Automated post-payment recovery system using standard paper and electronic claim formats, including pharmacy
  • Implementation of Michigan’s MMIS replacement system, CHAMPS
  • CMS Certification of CHAMPS
  • Transition to the X12 5010 and NCPDP D.0 formats
  • ACA Administrative Simplification requirements for operating rules for HIPAA transactions
  • Transition to the International Classification of Diseases 10th Revision (ICD-10)

Altarum services include:

  • Project management and oversight
  • Subject matter assistance with requirements gathering and design
  • Development of User Acceptance Test plans and scripts
  • User Acceptance Test management and oversight
  • Subject matter assistance with external trading partner readiness and testing
  • Assist with post implementation evaluation and optimization