The Member functionality within ND MMIS allows you to search for and view a summary of a member's current information and previous information. You can also view information about a member's benefit and service limits and eligibility.
You can view information about appeals and administrative hearings and, with appropriate authority, add information about these.
Much of the information for the State’s Medicaid and non-Medicaid members is stored and maintained on systems external to ND MMIS, such as VISION and the Technical Eligibility Computer System (TECS) systems. North Dakota MMIS Web Portal allows you to view and edit this information. Eligibility for all programs other than Medicare Supplemental Security Income (SSI) Buy-in is maintained on systems external to ND MMIS, such as VISION and the Technical Eligibility Computer System (TECS) systems.
North Dakota pays Medicare insurance premiums as part of the SSI Buy-in process for members who are dually eligible in Medicaid and Medicare. For the most part, people eligible for Medicare do not pay a premium for Part A coverage since this premium was paid as part of their payroll taxes when they were working. In general, Part A covers inpatient and outpatient care in hospitals, including critical access hospitals, and some care in skilled nursing facilities after a qualifying hospital stay. It also helps cover hospice care and some home health care. Most people pay a monthly premium for Part B. In general, Part B covers doctors' services and other outpatient care. It also covers some other medical services that Part A does not cover (e.g., some physical and occupational therapy services and some home health care. The state covers any premiums associated with purchasing Medicare coverage for its members, as identified by CMS. The buy-in processing generates financial claims for each member corresponding to their buy-in premium amount passed on the monthly billing file from CMS. Financial transactions are generated for each selected member with the Payee being CMS. The actual payment is sent to a third party (Bank of North Dakota) who then transfers the funds to CMS.
To edit member information, use Member Maintenance. Your user ID determines whether you have the proper security to use Member Maintenance. If not, you only have security to view member information and must use Member Summary Inquiry.
In some cases, member information must be merged into one ID or split apart (unmerged) into separate IDs. Using the Transfer Claims function, you select the appropriate claims to transfer from one ID to another. You must also manually correct and enter additional information about the two members when unmerging IDs.
If you have appropriate authority, you can add a new member using North Dakota MMIS Web Portal if the State program to which the member belongs does not send member information to ND MMIS through an automated interface. Normally, members are added in the source system, such as the VISION and the Technical Eligibility Computer System (TECS) systems. However, programs such as Department of Corrections, State Hospital Institutions Psychiatric Services, Women’s Way, North Dakota Youth Correctional Center, Children's Special Health Services (CSHS), and Disability Determination Services (DDS) use North Dakota MMIS Web Portal to enter their member's information into ND MMIS.
What Is Member Summary Inquiry?
What Is Benefit/Service Limits Inquiry?
What Is Eligibility Quick View Inquiry?
What Is Member Appeals Inquiry?
What Is Add New Member Appeals?
About Merging Suspect Duplicates
What Is Unmerge Alternate ID Transfer?
Version as of 5/16/14.
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