DMAS MES Informational Video

I want to it to a very important program here at dmoz mez simply put mez is a program to build a new enterprise class Medicaid management system which will replace the existing system known as Vanis this is an important program for demas as we’re responding to requirements from the Centers for Medicare and Medicaid Services known as CMS CMS has a vision to have States replace Medicaid management information systems built with old technology Virginia’s existing system is based on older all-in-one box technology using CMS Mitas standards mez will be modular fast upgradable and bring more capabilities for example mez uses modules representing all the complex processes which are currently part of vanna’s modules can be upgraded or replaced in order to introduce new capabilities without disturbing other parts of the system with advanced reporting and control capabilities mez will provide DMS with a system focused on business based decision making including advanced reporting and fraud detection mez will complete the integration and testing of all modules and will become fully operational in 2020 mez will also provide a new level of service for members and providers with web-based portal access taken as a whole mez is quite comprehensive it includes connections to other systems or entities including sister Commonwealth agencies managed care organizations external vendors and training partners let’s look at the individual modules which are the heart of men’s mez modules are connected with the integrated services solution or ISS ISS can be thought of as the central coordinator for all of the information flowing through men Deloitte is ensuring a well-managed integration of modules and data with ISS first operational in 2017 the encounter processing solution or EPS coordinates secure data communication with external entities like MC OS ApS also checks the data to ensure it’s formatted correctly and completely data is then supplied to ISS and the enterprise data warehouse for use by mez modules already certified by CMS EPS was developed in-house using DMS resources and talent the pharmacy benefit management solution for PBMs utilizes Magellan RX technology to manage pharmacy benefits across provider and member communities also certified by CMS PBMs utilizes a commercial off-the-shelf or cots solution from Magellan rx PBMs manages pharmacy benefits for Medicaid members drug rebates and transactions and payments by utilizing new pharmacy benefit technology d mass was the first to interface with labs to provide further analysis and reporting capabilities the enterprise data warehouse solution or Eid EWS is the main storage repository for data within meds EDW s receives and supplies data on demand to mez modules through ISS Optim a solution for e DWS also provides interactive reporting and is the source for data analytics capabilities for users provider services known as PR SS uses the DX e cots cloud-based solution the PR SS module provides overall management for provider related activities like provider enrollment screening and maintenance PR SS users will be able to monitor provider enrollment work clothes and reference reporting capabilities through the PR SS portal care management called CRMs shares patient health information with MC OS through member transition reports to improve quality and safety for members CRMs integrates medical behavioral health and long-term services by creating and maintaining a comprehensive set of health records just like eps crms was developed internally by DMS the third-party liability recovery solution or TP l RS has a number of financial related functions for example TP l RS is primarily responsible for identification and recovery of damask payments from providers members insurance companies trusts and others TP l RS also generates accounts receivable invoices for Oracle financials the payment processing management solution or PMS uses a solution provided by conduit and manages financial transactions including budgets disbursements and bank reconciliation the appeals module manages member and provider appeals providing document management capabilities including generation of correspondence and notifications advanced reporting capabilities are built in automated workflows allow accelerated appeals processing time clients and deem a staff interact with the system via a web-based portal operations and the planned management solution known collectively as opss and PLMS is a solution provided by Accenture and spans all areas of mez functionality including member information like updates enrollments case management and more plan management including benefits coverage management audit management fee schedule and rate management opss and PLMS also managed provider information from PR SS and includes an operational data store with reporting dashboards and inbound mailroom opss also receives service authorizations and leverages claim adjudication for care management while sharing data was CRM s financial and care management are also handled by interactions with ppm s CRMs and other modules 2019 is a very busy year for the mez program while two modules EPS and PBMs are already operational the remainder of mez will be tested and become operational by mid 2020 once complete Virginia’s Medicaid enterprise system will be one of the first complete systems in the nation mez will provide better services for our members our providers and DMS by reducing costs and introducing and maintaining the latest technology for a complete solution

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