SCDHHS to Replace its Medicaid Management Information System

Staff Report From South Carolina CEO

Tuesday, March 10th, 2020

The South Carolina Department of Health and Human Services (SCDHHS) is replacing its Medicaid Management Information System (MMIS) with a more efficient, modern system that will reduce administrative burden on providers.

SCDHHS is using a step-by-step, modular process to transition from the MMIS to the Replacement Medicaid Management Information System (RMMIS). This includes the implementation of multiple system and service modules. Some of these modules have already been implemented, including the accounting and finance module, business intelligence system (BIS), pharmacy benefits administrator (PBA) module and the third-party liability (TPL) module.

SCDHHS is now conducting planning and business requirements sessions for the design and configuration of the administrative services organization (ASO) module of the RMMIS. The ASO is responsible for provider management and enrollment, the adjudication of medical (non-pharmacy and non-dental) claims and prior authorizations. SCDHHS has selected Optum, through a competitive procurement, as the contractor to implement the ASO.

Ensuring providers understand how the implementation of the RMMIS will affect them is important to the project’s success. Over the implementation period, South Carolina Healthy Connections Medicaid providers will receive regular updates, opportunities for trainings and demonstrations and information about the RMMIS from SCDHHS through Medicaid alerts and a new RMMIS newsletter. Providers and other stakeholders can sign up for the RMMIS newsletter by updating their email subscriber preferencesto include RMMIS news and updates. The RMMIS subscription is located under “Programs and Initiatives.”