Mechanized Claims Processing

Mechanized claims processing and information retrieval system or system means the system of software and hardware used to process Medicaid claims from providers of medical care and services for the medical care and services furnished to recipients under the medical assistance program and to retrieve and produce service utilization and management information required by the Medicaid single state agency and federal government for program administration and audit purposes.  The system consists of (1) required subsystems specified in the State Medicaid Manual (2) required changes to the required system or subsystem that are published in accordance with 433.123 of this subpart and specified in the State Medicaid Manual; and (3) approved enhancements to the system.  Eligibility determination systems are not part of mechanized claims processing and information retrieval systems or enhancements to those systems.

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