Human Services Secures $19 Million From Federal Government To Process Medicaid Claims

ST. CROIX — The Department of Human Services announced on Monday that it had received a grant award of $19,628,107 from the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services.

“This federal grant award was approved and issued to the Virgin Islands Government on September 7, 2016 in support of the territory’s Medicaid Management Information System (MMIS). Since October 2012, the department has contracted out these services with Molina Medicaid Solutions,” said Ms. Roberts.

When Medicaid members are rendered services, the MMIS adjudicates health care claims related specifically to Medicaid covered services, according to D.H.S. Claims can now be submitted electronically to the Medicaid Program through the VIMMIS, which is consistent with HIPPA requirements. This is real-time claim status and payment information available to the provider and the claim submitter, D.H.S. says.

“Our access to this technology places the Virgin Islands on the same playing field with the other states. Moreover, these claims are adjudicated within six seconds. This ability has hastened timely payments to enrolled providers each week. Enrolled providers can verify member eligibility, obtain real-time claim status, receive electronic remittance advice, and submit requests for authorizations online through the secure provider web portal,” Ms. Roberts explained.

D.H.S. says it has once again entered into a contract with Molina Information Systems Inc., doing business as Medicaid Solutions, effective September 1, 2016, through December 31, 2022, as secured by Ms. Roberts. This agreement satisfies federal requirements regarding the processing of Medicaid claims in the Virgin Islands, according to the release.

“We are extremely confident that Molina will provide the outlined services that are agreed upon with professionalism and in the interest of the Virgin Islands Medicaid subscribers. The MMIS enables the VI Medicaid Program to accurately track and report its use of federal funds as well as the local share (match), which was not the case prior to the implementation of the MMIS. Our partnership with Molina Medicaid Solutions validates the Virgin Islands’ use of a CMS-certified management information system,” Ms. Roberts concluded.