A Pathway to Dual Eligible Data Integration: Maximizing Coordination of Benefits, Services, and Payments through the Massachusetts MMIS

Abstract

We have partnered with MassHealth, Massachusetts’ Medicaid program, to develop and deploy precision data integration methodologies within the Massachusetts Medicaid Management Information System (MMMIS) to maximize coordination of benefits, services and payments for Medicaid recipients with current or potential dual eligibility for Medicare. Integration strategies and coordination benchmarks are used to ensure accurate Medicaid and Medicare enrollment; fully engage service delivery options (including managed care and integrated care programs); and effectively cost-avoid, reprice, or cost-share to ensure the state’s lowest payment liability.