Nebraska Medicaid Program

Current Initiatives

MMIS Replacement Project

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NEWNebraska MMIS Replacement Procurement Information
 
Nebraska Medicaid is moving past analysis stages and into the procurement of its MMIS Replacement Project. The project continues to support an innovative, modular, and phased approach. An informational document outlining several components of the project is available at the following: LINK

The Medicaid Management Information System (MMIS) is comprised of functionality within a number of systems that provide support for the administration of Nebraska’s Medicaid Program.  The MMIS processes claims, supports coordination of benefits, assists in surveillance and utilization review of claims payments, generates federal and management reporting, and provides case management tools.

The federal government certified the current MMIS in 1978 and, although it has satisfactorily met its original objectives, it has become increasingly difficult to maintain and enhance because of outdated technologies in the automated application. Efforts to enhance the system over the past decade have improved some of the Medicaid Program operations.

Recognizing the need to implement new technology, and with the support of the Legislature, DHHS has embarked upon a phased approach to replace the MMIS functionality.

MLTC has performed the strategic planning analysis necessary for a project of this size.  The strategic planning analysis included the review of potential alternatives and procurement strategies.  In the final analysis, MLTC determined that the Medicaid program would best be served by a Medicaid Enterprise modular approach to replace existing MMIS functionality.  Program decisions such as the formation of the new Heritage Health managed care program and future procurement of a dental benefit management plan impacted the approach for the MMIS replacement.    As DHHS was procuring an Enrollment Broker to manage enrollment for the Heritage Health program, DHHS decided that capitation processing was a logical inclusion in the enrollment broker scope.  Further, the expected volume reduction in fee-for-service claims led to the decision to move forward with utilizing one of the Heritage Health plans as a claims broker service (CBS) to process fee-for-service claims.  The top priority for the MMIS replacement project in support of the new programs is improving data management and analytics (DMA).  Therefore the project team will be procuring a DMA contractor to implement and operate a new DMA solution.

MLTC intends to contract with external vendors to fulfill the components of this planned approach through the release of multiple requests for proposals (RFPs). The following RFP document have been released:

The following RFP is in the planning stage:

  • Independent Verification and Validation (IV & V): Traditional Medicaid IV & V services spanning multiple projects. Targeted release - February 2016.

All RFPs are published by the Nebraska Department of Administrative Services at http://das.nebraska.gov/. For questions regarding the MMIS Replacement Planning Project, please send an e-mail to DHHS.MMIS@nebraska.gov.  Updated information will be shared as it becomes available.


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