Illinois is in the process of modernizing its 30 year old Medicaid Management Information System (MMIS) system. This step was taken, in large part, to meet federal requirements in the Affordable Care Act. In modernizing the dated MMIS system, Illinois has addressed previous challenges, including support for advanced administrative functions, such as claims processing from providers and eligibility verification of Medicaid enrollees.
Five agencies are working together to develop an MMIS that standardizes, expedites and simplified processes for providers serving Medicaid clients:
- Illinois Department of Healthcare & Family Services (HFS)
- Illinois Department on Aging (IDoA)
- Illinois Department of Children & Family Services (DCFS)
- Illinois Department of Human Services (DHS)
• Division of Alcoholism and Substance Abuse (DASA)
• Division of Family & Community Services, Bureau of Early Intervention (EI)
• Division of Developmental Disabilities (DDD)
• Division of Mental Health (DMH)
• Division of Rehabilitation Services (DRS)
- UIC Department of Specialized Care for Children (DSCC)
The impetus for IMPACT:
HFS currently manages and operates the MMIS to support claims processing for the Illinois Medicaid Enterprise. The MMIS environment includes the database subsystems (e.g., Provider, Recipient, Reference and Prior Approval); the Hospital, Pharmacy and NIPS claims processing subsystems; the Management and Reporting System (MARS); the Enterprise Data Warehouse; the Pharmacy point of sale system and the web-based applications provided in the Medical Electronic Data Interchange(MEDI) system.
The current MMIS was fully implemented in 1982, and was primarily built to support a fee-for-service Medicaid program. Throughout the years, HFS made many enhancements and modifications to the MMIS; however, it is an older legacy system that is becoming increasingly more difficult to maintain and modify. Additionally, the federal Centers for Medicare and Medicaid Services (CMS) has since developed the Medicaid Information Technology Architecture (MITA), a national framework to support improved systems development and health care management.
Rather than developing a new system, Illinois is obtaining a fully-operational, federally-certified MMIS partnership. This cloud-based approach is expected to decrease up-front development costs and reduce the time required for implementation by two years.
The first phase of IMPACT: eMIPP
The first phase of IMPACT included the launch of the Electronic Health Records Medicaid Incentive Payment Program (eMIPP), which provides incentive payments to eligible professionals, eligible hospitals and critical access hospitals to adopt, implement, upgrade or demonstrate meaningful use of certified electronic health records (EHR) technology. As part of that effort, Illinois launched Medical Electronic Data Interchange(MEDI), a secure provider web portal for authorized users to access and submit Medicaid information.
The eMIPP program will continue until 2021. The last year a Medicaid provider may begin participation in the program is 2016. More information about eMIPP is available at Medicaid.Illinois.gov.
The current phase of IMPACT: Provider Enrollment
Beginning in July, 2015, providers seeking to serve Medicaid clients will be required to enroll and revalidate through the new IMPACT web portal. Paper enrollment applications or updates will no longer be accepted, and email will become the primary method for provider communication.
Existing Medicaid providers enrolled in the current legacy MMIS will be required to revalidate their information in the new IMPACT system during a 6 month revalidation period between August, 2015 and January, 2016. Subsequently, providers who deliver services through Medicaid waiver programs —including providers who have previously not been required to enroll in MMIS— will need to enroll in IMPACT beginning in 2016.
Please see the Provider Enrollment page of this website for more information about the phased approach to Provider Enrollment - including more details about which types of providers are expected to revalidate in 2015, and which types of providers will begin using the system in 2016.
Later phases of IMPACT: PBMS and Full Implementation
In the fall of 2016, IMPACT will launch a new Pharmacy Benefits Management System (PBMS). More information about the PBMS can be found at ILLINOIS Rx Portal.
In 2018, Illinois will transition to using a single web-based system for all Medicaid claims processing – referred to as “full IMPACT implementation.” More information about full implementation will be provided through this website as the project moves forward.