MES PORTAL

The North Carolina Department of Health and Human Services' (NCDHHS) Medicaid Enterprise System (MES) supports the State's Medicaid program through its facilitation of interoperability between Medicaid systems.

MES Modules

A modular MES is made of independent and interoperable modules. An ideal modular system includes cloud-based or COTS-based components.

Medicaid Integration Services

Medicaid modules will exchange the data through MIS. It has Managed File Transfer, MES Landing Page and API components.

Pharmacy Benefit Administrator

The Pharmacy Benefit Administrator (PBA) system supports point-of-sale (POS) pharmacy claims processing, medication formulary and utilization management, prior authorization services, drug rebate processing for North Carolina, and custom clinical programs.

NCTracks

NCTracks, the multi-payer Medicaid Management Information System for the NC Department of Health and Human Services (NCDHHS), coordinates provider enrollment, credentialing, and ongoing data maintenance through web applications, and supports additional fee-for-service operational activities including prior approval and claim adjudication. It has three separate portals (Providers, Recipients, and internal Operations ) which offer different functions based on the unique needs of the users.

Interoperability

The Interoperability (IO) System provides a seamless flow of data between payers, both within and outside of, the North Carolina Medicaid ecosystem, as well as provides Medicaid Direct members the ability to access their Medicaid information via third party apps. By navigating to this application users will have the ability to access third party application vetting questionnaires, access the applications for operations and maintenance purposes, or view Interoperability reports.

Encounter Processing

The Encounter Processing Systems (EPS) ingests Institutional, Professional, and Pharmacy encounter data from Prepaid Health Plans (PHP) and Prepaid Inpatient Health Plans (PIHP). Encounter data are the records of services delivered to Medicaid beneficiaries enrolled in managed care plans that receive a capitated, per-member-per-month payment. These records allow North Carolina Medicaid to track the services received by members enrolled in managed care. The state is not responsible for processing a claim or paying the provider for the rendered service. Encounter data typically come from billed claims that providers submit to managed care plans to be paid for their services and sends quality transaction feedback back to the plans to ensure appropriate industry standard format.

Data Analytics Platform

Enterprise data analytics platform that serves as a repository for the Medicaid data supplied from disparate systems such as NCTracks, Encounter Processing System (EPS), NCFAST, health plans, etc. Medicaid data includes medical & pharmacy fee-for-service (FFS) claims, managed care encounter data, provider data, member demographics, member eligibility & enrollment, electronic visit verifications, financial data, prior authorization, reference data, and other data elements. DAP provides an integrated reporting and analytics platform to perform data exploration, reporting, and visualizations to extract meaningful insights and make informed decisions.

Electronic Visit Verification

Electronic Visit Verification (EVV) is a telephone and computer-based solution that electronically verifies in-home service visits.

About MES Portal

MES Portal is a gateway for all the Medicaid Modules.