WAG 22-08-07.

This system provides medical coverage information for all clients. Information remains in the system 24 months after a case is canceled. MMIS provides general information about:

  • Client medical eligibility including:
    • Health Maintenance Organizations (HMOs);
    • Recipient Restriction Program (RRP);
    • spenddown status when met;
    • beginning medical eligibility date and the date ("SYSDTE") posted to the file;
    • Hospital Insurance Benefits (HIB) and Supplementary Medical Insurance Benefits (SMIB);
    • Qualified Medical Beneficiary (QMB);
    • Specified Low-Income Medicare Beneficiary (SLIB);
    • prior approval (information displayed for prior approval requests, including the date of request for prior approval, disposition date, approval for payment, amount approved, or denial reason);
    • Third Party Liability (TPL);
    • medical extensions; and
    • type action (TA) that was used.
  • Utilization Review - Tracks the client's use of medical services including the beginning and ending medical eligibility dates, the provider code, name of the primary care provider or HMO, provider number, and effective dates of restriction for a restricted client.
  • Long Term Care - Gives the history of a nursing home case in date sequence, including information about bed reserve, provider number, and credits.