What Is MMIS in Medicaid? How NEMT Providers Use the State Claims System

When you enroll with Medicaid, check a rider’s coverage, or look up why a claim paid short, you are using your state’s MMIS. Most owners know it only by its local name. Knowing what it is helps you find the right portal, the right phone line, and the right place to fix a problem.

What MMIS means in Medicaid

MMIS stands for Medicaid Management Information System. Federal rules define it as the system a state uses to process providers’ claims for Medicaid payment and to run the rest of the program’s operations, management, and oversight (42 CFR 433.111). A separate eligibility and enrollment system handles member applications, changes, and renewals.

Three facts explain why every state’s system looks different:

• Federal money pays for most of it. CMS pays 90 percent of the cost to design, develop, or install an approved claims system and 75 percent of the cost to run it (42 CFR 433.15).
• A contractor may run it. Medicaid.gov says a fiscal agent, a private contractor the state normally selects through competitive procurement, may operate the state’s MMIS.
• It can be many systems. Since the federal definition allows a “system of systems,” a state can run enrollment, claims, and reporting as separate modules with separate names.

How NEMT providers use the MMIS

Task	What you do	Example
Enroll	Apply as a transportation provider in the state’s enrollment module, and revalidate at least every 5 years (42 CFR 455.414)	Illinois requires every transportation provider, health plan or fee-for-service, to enroll in IMPACT
Check eligibility	Look up the rider on the portal, call the phone line, or send a 270 inquiry	Indiana’s portal marks members whose rides go through Verida as Fee for Service + NEMT
Get the trip authorized	Get the authorization number the claim needs	New York’s broker issues an 11-digit prior authorization number after you attest the trip was completed
Bill	Submit on the portal, as an 837P file, or through a vendor	Texas takes Medical Transportation Program claims through TexMedConnect or a third-party vendor
Get paid and reconcile	Read the remittance advice or the 835 file, and track payments	Texas issues a weekly Remittance and Status report and offers an 835 file

The file formats are federal standards: the 837 professional claim (version 005010X222), the 270/271 eligibility inquiry and response (005010X279), and the 835 payment and remittance advice (005010X221), under 45 CFR 162.1102, 162.1202, and 162.1602. See Medicaid eligibility verification, how to submit NEMT claims electronically, and how to read remittance advice. A clearinghouse can send your claim files for you.

When you bill a broker instead

Where a broker pays you, you may never send a claim to the MMIS. Indiana’s transportation module (version 6.1, August 19, 2025) says providers bill fee-for-service trips arranged by Verida to Verida. Emergency trips and most trips exempt from the broker go to the state through the IHCP Portal, an 837P file, or a paper CMS-1500. See fee-for-service Medicaid for who pays in each model.

Your broker trips usually still reach the MMIS. Federal rules require health plans, including brokers the state pays only for rides, to send the state encounter data for every service, in the standard 837 format and, where appropriate, the 835 (42 CFR 438.242, applied to ride-only brokers by 42 CFR 438.9). Georgia’s NEMT manual (July 1, 2026) shows how it works:

1. The broker submits encounter data on each trip for Medicaid members in its area.
2. The state processes it like a claim, but no payment is made.
3. The data is due 30 calendar days after the month the broker paid, reported by month of service.
4. Each procedure code carries an origin and destination modifier, such as R for residence and J for a dialysis facility.

The result is a state record of every trip the broker paid for.

MMIS names by state

These are the systems NEMT providers deal with in eight states, from each state’s own manual or portal, as of September 2026.

State	System or portal	What NEMT providers use it for
New York	eMedNY	Claims for trips the broker authorized, using the 11-digit prior authorization number (transportation manual effective August 25, 2023)
Texas	TMHP, the state’s claims administrator, with TexMedConnect	For Medical Transportation Program trips, demand response (DRTS) and transportation network company (TNC) providers enroll with TMHP, in-state providers file claims within 95 days of the trip, and payment reports come weekly (handbook, September 2026)
Illinois	IMPACT for enrollment. REV, the phone line at 1-800-842-1461, and MEDI for eligibility	Enrollment for every transportation provider, and electronic billing for every claim (handbook, March 11, 2024)
North Carolina	NCTracks, the state’s multi-payer MMIS	Enrollment and claims. For NC Medicaid Direct trips, the county submits a prior authorization that carries the rate, and each claim is based on it (bulletin, December 19, 2025)
Indiana	IHCP Provider Healthcare Portal	Eligibility checks, and claims for trips exempt from the broker (module, August 19, 2025)
Georgia	GAMMIS	The NEMT policy manual and the 837P companion guide. Brokers send the state encounter data for each trip (manual, July 1, 2026)
Arizona	AHCCCS Online Provider Portal	Fee-for-service claims. Since November 1, 2022, NEMT claims must include the pickup and drop-off addresses (billing manual chapter revised July 31, 2026)
Wisconsin	ForwardHealth Portal	Enrollment. Specialized medical vehicle providers enroll at the high risk level and do not need an NPI

For other states, search your Medicaid agency’s provider page for “provider enrollment” and “provider portal,” or open your state guide. If a claim is stuck, how to check Medicaid claim status walks through each lookup.