Department of Social Services

Medicaid Claims Processing Accuracy

The Medicaid Management Information System (MMIS) is a centralized, automated medical assistance information and payment system that is operated by a fiscal agent under a contract with the Department. The State Comptroller maintains audit staff on site at the Department to conduct continuous audits of the MMIS, including weekly examinations of the accuracy of the Medicaid claims that are processed. During the year ended March 31, 1995, these weekly examinations found that health care providers were overpaid as much as $6.2 million and underpaid as much as $200,000. Most of these overpayments and underpayments were made because providers incorrectly completed their claim forms and the MMIS could not accurately process certain types of large claims. 95-D-6