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MMIS User Training Course Descriptions The following MMIS user training courses are currently available for DHS and local government staff. Approval from managers is required for all courses. The first course, MMIS Fundamentals, is a prerequisite for all the others. It is self-paced and is available as a downloadable class through the DHS Learning Center. All other courses will be classroom-based.
For more complete descriptions of these courses, please click here.
1. MMIS Fundamentals A self-paced course that is a prerequisite for all other training courses. It offers users a series of 30-40 minute modules, each providing a description of one of the subsystem functions within the new MMIS -- as well as additional modules describing basic navigation, search, and inquiry functions. MMIS users will learn how to access the help function and access the online user manual.
2. Benefit Plans and Assignment Plans Provides DMAP, AMH, SPD, and other MMIS users the skills they need to define the sets of Medicaid covered services and other state sponsored services that will be offered and paid using the new MMIS. By defining benefit plans within the system, the claims engine will know which procedures and services may be paid when claims are submitted by providers. MMIS users will learn how specific edits and audits within claims are driven by the criteria entered into the benefit plan panels.
3. Health Services Commission (HSC) List Trains MMIS users in how, once covered services have been determined, the automated HSC update process is managed within the MMIS. The course also covers how staff with the proper system access permissions may make manual updates to the HSC list. Trainees will learn how to test and promote updates and how to verify that updates are in place.
4. Updating Reference Data - Claims and Benefits
5. Incoming Claims, Adjustments, and Voids Orients claims processing MMIS Users to the panels they need to perform single claim adjustments, and mass adjustments to multiple claims.
6. Claims Resolution Provides claims processing and claims resolution MMIS users with the skills they need to route claims that hit specific edits and audits to predetermined claim locations and to resolve those claims. Among the subjects covered will be updating the disposition of a claim, adding or changing claim resolution routing parameters and looking up a claim or series of claims.
9. Monitoring Claims Processing - Encounter, Fee for Service (FFS), and Pharmacy The Claims Monitoring course provides claims processing MMIS Users with a set of processes and reports that may be used to review a claims processing cycle. Claims processing includes: Encounter, Fee for Service (FFS), and Pharmacy claim types.
13. Managed Care Contracts Prepares managed-care contract-management MMIS users to access the contract management panels needed to track requests for applications, establish a managed care contract in the MMIS and set the initial rates for a contract. Among the subjects covered will be entering and tracking requests for applications, inquiring on existing contract data and setting and maintaining contract rates.
14. DSS Reporting for the Ad Hoc and QA User Provides an overview of the Medicaid data warehouse and the Decision Support and Utilization Review system (DSSUR) to DHS staff that need to access claims, provider, recipient, and other data. The course is designed to help users learn how to use the reporting tool. Not all reports will be covered in the training course or exercises. Users can expect to see a sample of the DSSUR reports.
15. DSS Reporting for the Power User Provides DSS users with an overview of the Medicaid data warehouse and the Decision Support System. Among the subjects covered will be generating complex SQL (Standard Query Language) statements, combining SQL statements to generate queries and storing, and maintaining SQL statements for later use.
16. DSSSUR Maintenance Prepares specific DHS staff to maintain the table data that drives the surveillance and utilization review process. DSSUR users will learn to maintain case type table data and case group table data, and maintain healthcare measures table data.
17. ODM Incoming Prepares Office of Document Management (ODM) batch specialists, keyers, and verifiers to recognize the existing and new forms that will be accepted and processed through the system new Electronic Document Management System (EDMS). Among the subjects covered will be recognizing updates to the Prepare and Image claim forms, claim adjustments and checks processes.
18. Recipient Eligibility Data Provides eligibility interface MMIS users with the skills they need to verify that source system eligibility data was delivered and that updates to the MMIS eligibility tables were successful. Among the subjects covered will be recipient eligibility data inquiries (including reviewing current and historical eligibility data stored in the MMIS); reviewing a recipients managed care enrollment status; and reviewing third party resource data, injury case tracking data and effective dates.
19. Managed Care Enrollment Prepares managed care MMIS users to enroll recipients into managed care organizations and to maintain enrollment data. MMIS users will learn to inquire on existing managed care enrollment data for a recipient, enroll a recipient into a managed care plan, maintain a recipients managed care enrollment data and dis-enroll a recipient from a managed care plan.
20. TPR (Third Party Resource) Eligibility Prepares Third Party Resource MMIS users to use the TPR panels to manage TPR identification data submitted by DHS staff. MMIS users will learn to identify and verify potential Third Party Resource coverage for a recipient, including the use of the HIPAA 270/271 eligibility verification request and response transaction. They will also learn to add and change health insurance premium payment data for a recipient. MMIS users will learn to create and maintain TPL carrier and TPL employer data.
21. Account Payables Prepares financial MMIS users to process provider payments, and track expenditures. Among the subjects covered will be creating and tracking payouts such as non-claim-related payments, refunds, transportation expenses, and cost settlements; generating payout letters; and creating and tracking manual checks per DHS business rules.
22. Account Receivables Prepares financial MMIS users to track and process replacement checks and Electronic Fund Transfer (EFT) transactions. Among the subjects covered will be setting up and maintaining accounts receivables transactions, setting up auto recoupments and monitoring automated accounts receivables.
23. Cost Settlements Prepares financial MMIS users to enter and track cost settlement data in the MMIS. Trainees will learn to perform provider audits using DSSUR and generate and track cost settlements using accounts receivable set up and A/R-tracking business processes.
24. Estate Recovery Prepares financial MMIS users to set up and track estate recovery cases. MMIS users will learn to create, track and maintain an estate recovery case.
25. Financial Cycle Scheduling Prepares financial MMIS users to access the MMIS financial panels to manage the claims payment and financial transaction processing cycle. Among the subjects covered will be configuring the elements processed in the MMIS financial cycle including payers, claim types, and financial transactions; changing the frequency and payment criteria for a financial cycle; setting Fiscal Pend criteria; and maintaining Remittance Advice Banner Page data.
26. Financial Reporting Prepares financial MMIS users to make corrections to provider 1099 data. MMIS users will learn to reconcile remittance advice and review the panels and processes used to verify the Combined Check Reconciliation System (CCRS) and Statewide Financial Management Application (SFMA) interfaces.
27. Management and Administrative Reporting (MAR) Provides financial MMIS users with the skills they need to access the MAR reports functions, view predefined MAR reports, and use parameter-driven queries to display and analyze data used to build the MAR reports. Among the subjects covered will be reviewing pre-defined MAR reports and using report criteria to generate and review the following MAR reports: expenditure reports, long term care reports, operations reports, provider reports and recipient reports.
28. Provider Third-party Liability (TPL) Billing Prepares TPR and financial MMIS users to process third party recoveries collected from insurance carriers. Among the subjects covered will be setting up and tracking a manual TPL accounts receivables, tracking TPL accounts receivables and post-payment recoveries, and processing manual recovery receipts.
29. TPR Eligibility and Injury Case Tracking Prepares TPR MMIS users to set up and track injury cases. MMIS users will learn to set up and track a TPL injury case, process the injury diagnosis and Department of Motor Vehicles report, and monitor TPL Receivables.
33. Role Based Security Provides OIS and other designated system support staff with the skills they need to add and modify user login and password data. Among the subjects covered will be adding a new user security role, maintaining existing user security roles, maintaining Web portal access security roles and administering user logins and passwords.
34. Member & Provider Call Center (CTMS) The Member & Provider Call Center Course will prepare Call Center MMIS Users to track incoming calls from recipients and providers. Users will learn the functions of the CTMS including Call Tracking, Issue Transfer, and High Priority Notes. The course includes instruction on accessing and tracking correspondence between DHS and recipients, and DHS and providers.
35. Pharmacy Benefit Management (PBM) Provides DHS PBM MMIS users with the skills they need to oversee and monitor the PBM operations carried out by EDS. Among the subjects covered will be reviewing drug file update reports and PBM reports, overseeing the drug State Maximum Allowable Cost (SMAC) price resolution processes and overseeing updates to Drug Utilization Review (DUR) alerts.
36. Maintaining Providers Enables provider enrollment MMIS users to track and update provider enrollment data. Among the subjects covered will be how to inquire on an existing provider; how to update provider information including credential, license, contract, location and rate data; and how to update provider owner panels.
38. Provider Correspondence Prepares provider enrollment and provider relations MMIS users to accept and track correspondence between providers and DHS. MMIS users will learn to identify and track provider correspondence, view images of paper documents in EDMS, create a CTMS record and process returned mail and email.
39. Provider Enrollment/Disenrollment Prepares provider enrollment MMIS users to enter and track provider enrollment applications. MMIS users will learn to enroll, re-enroll, disenroll, inactivate and reactivate providers. They will also be trained in adding a sanction for a fee for service or managed care provider, adding a restrictive service, and entering EFT data.
40. Case Management Provides an overview of the quality assurance and utilization management functions in the MMIS. MMIS users will learn to inquire on a recipient case, extract recipient and claims data using the DSSUR, and track case management vendor activities.
42. Fraud and Abuse Prepares Quality Assurance and Utilization Management MMIS users to use the DSS to run reports that show potential abuse of Medicaid services by recipients or providers. Among the subjects covered will be using the DSSUR functions to extract data for subsequent fraud and abuse analysis, running pre-defined targeted queries and updating Explanation of Medical Benefits (EOMB) criteria.
43. Plan of Care Prepares AMH and DMAP MMIS users to establish a Plan of Care for a specific recipient. Among the subjects covered will be adding a new Plan of Care for a recipient or set of recipients, modifying an existing Plan of Care and maintaining Plan of Care effective dates.
44. Prior Authorization Provides MMIS users with the skills they need to generate and maintain service authorizations. Among the subjects covered will be creating and tracking a prior authorization (PA), identifying the services allowed on a PA and monitoring the number of services applied to a PA.
45. MMIS for the Local Office - Data Inquiry & Update This course will provide MMIS Users in the DHS Local Offices with an Introduction to the MMIS and training specific to the business functions they need to review recipient eligibility and managed care enrollment.
53. MMIS for the Local Office - SPD Plan of Care Prepares SPD staff to generate a new Plan of Care for a specific recipient, inquire on an existing Plan of Care, and maintain an existing Plan of Care as updates to the plan are needed.
55. MMIS for the Local Office - Account Payables Prepares staff in the local offices to process specific check processing and payable accounting transactions in the field office. Among the subjects covered will be creating and tracking emergency and manual checks, adding and tracking stop payments and re-issuing or voiding checks.
56. Non-Managed Care Contracts Prepares contract management MMIS users to access the contract management panels needed to track requests for applications, establish a non-managed care contract in the MMIS, and set the initial rates for a contract. Among the subjects covered will be entering and tracking requests for applications, inquiring on existing contract data and setting and maintaining contract rates.
57. Buy-in BENDEX Prepares Third Party Resource MMIS users to use eligibility and buy-in panels and reports to manage TPR data relative to Medicare. Among the subjects covered will be monitoring the processing of Federal BENDEX, Medicare Buy-in and Medicare Part D pharmacy benefit coverage data and their respective updates to recipient eligibility data.
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