Virginia Medicaid

MMIS Outage March 30 through April 3

This is an important message from the Virginia Department of Medical Assistance Services. The Medicaid Management Information System (MMIS) will pause operations beginning on Wednesday, March 30, and continuing through Sunday, April 3. Long-term services and supports (screenings) will pause the electronic system starting Tuesday, March 29, and continuing through Sunday, April 3. This pause is necessary as we prepare to launch the new Medicaid Enterprise System (MES).

During this outage, Medicaid providers will not have access to MMIS to verify the eligibility of members in fee-for-service in real-time using Medicall or the Automated Response System. Providers will not be able to access the portal for waiver/Nursing Facility level of care entry or entries into the electronic screening and assessment system. Managed care network providers will be able to verify the eligibility of managed care members through the appropriate managed care health plan. Magellan Behavioral Health Services Administrator providers will be able to verify the eligibility of members through the Magellan portal.

During this temporary pause, you should continue to provide health care services to Medicaid members who present proof of eligibility in the form of a blue and white Medicaid ID card, a notice from the Virginia Case Management System, or a card for a managed care health plan.

Other MMIS functions unavailable during this five-day outage include:

  • Fee-for-service claims submission and processing
  • Service authorizations
  • Managed care encounters
  • Direct Data Entry of claims
  • MMIS Online
  • Provider functionality
  • Provider secure mailbox
  • Provider and member help lines
  • ePAS
  • Long-term Care
  • eDoc
  • 270/271 Eligibility Transactions - Switch vendors, HOpR

Information for Pharmacies

If a pharmacy claim denies with an NCPDP Error Code 52 (non-matched cardholder ID), please call 1- 800- 932-6648 and give the call center team the member’s full name, DOB, SSN, and demographic information. Magellan Pharmacy Benefits Management System will verify if the ID number is valid and provide the member ID to the pharmacy. If the Magellan Help Desk staff cannot locate a valid ID number, they  will provide a temporary dummy ID number in order for the claim to process correctly. 

During the week of April 4 to April 8, Virginia Medicaid staff will contact the pharmacy with the correct member ID and request that the pharmacy void the original claim and resubmit with the actual ID number.

DMAS will reimburse pharmacies for prescription claims filled in good faith for Medicaid members during this outage.