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Medicaid Management Information System

The Medicaid Management Information System (MMIS) is a composite of contracted systems at The Texas Medicaid and Healthcare Partnership and systems within the Health and Human Services Commission (HHSC) and the Texas Department of Human Services (DHS). These systems are grouped into seven functional areas:
  • recipients
  • providers
  • claims processing
  • reference files
  • surveillance and utilization review
  • management and administration reporting
  • third party liability

The recipient, provider, reference file, and claims processing subsystems function as an integrated unit with the overall objective to process and pay eligible providers for all valid Medicaid (Title XIX) claims on eligible recipients. The surveillance and utilization review and management and administrative reporting subsystems provide data consolidation, organization, and presentation which enable HHSC to manage its Title XIX program effectively.

MMIS systems operations are matched by the federal government at a 75/25 ratio. 


Report systems included in MMIS are:

blue dotMedical Administration
blue dotNursing Home
blue dotUtilization Review
blue dotHome & Community Based Services
blue dotA & D Worksheet Interface
blue dotBuy-in
blue dotPharmacy Claims
blue dotMedical Reports Series
blue dotRecipient Evaluation Profile Management System
blue dotTDMHMR Billing System
blue dotExplanation of Benefits
blue dotTitle XIX and Title XX Tracking Systems
blue dotMedical Identification Cards
blue dotDental Claims Payment
blue dotPeriodic Screening, Diagnosis and Treatment
blue dotMedical Payment History Review and Reporting
blue dotFamily Health Services
blue dotState Data Exchange
blue dotRecipient Utilization Control Management System
blue dotThird Party Resources Billing and Monitoring
blue dotHospital Utilization Monitoring
blue dotCommunity Care
blue dotWelnet A&D Medicaid Eligibility Determination
blue dotECM Vendor Drug
blue dotAFDC Batch Processing
blue dotSDX Batch Processing
blue dotAdoption Subsidy Program
blue dotAFDC Report Writing
blue dotOIG Interface
blue dotThird Party Resources
blue dotTEC Interface Match
blue dotPublic Assistance and Food Stamps
blue dotManaged Care


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