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IPRS (Integrated Payment and Reporting System)

Archived IPRS Information

The NC Division of MH/DD/SAS has developed an integrated payment and reporting system (IPRS) which replaced three former systems for claims processing. The IPRS was built on the existing Medicaid management information system (MMIS) which currently processes Medicaid claims. The IPRS tracks, pays and reports on all claims submitted by providers for services rendered. LME's submit a single claim to the state, and the IPRS processes the claim from the appropriate funding source.

New ICD-10 Deadline Set for October 1, 2014

On August 24, the Department of Health and Human Services (HHS) announced the final rule that extends the International Classification of Diseases, 10th Edition (ICD-10), compliance date from Oct. 1, 2013, to Oct. 1, 2014. In addition to codes that allow for greater specificity when classifying diseases and health problems, ICD-10 includes codes for new procedures and diagnoses aimed at improving the amount of detailed information available to healthcare providers for quality improvement and payment purposes. To view the complete release, visit the following this site.

For more information regarding NCTracks and the ICD-10 implementation, visit the OMMISS website at ncmmis.ncdhhs.gov. From the top navigation you can access more detailed information regarding both NCTracks and ICD-10 activities by clicking on the appropriate link.

The IPRS system:

• Provides an Integrated Payment and Reporting System to process and pay all Division and Medicaid claims through one system;
• Uses the claims processing engine of the North Carolina MMIS to process and pay claims for the Division of MH/DD/SA Services and leverage re-engineering efforts currently underway in the ITME project to provide multi-payer capabilities;
• Defines, designs, and constructs additional functionality required to meet the specific needs of DMH/DD/SAS;
• Provides increased flexibility to implement unique policy and payment strategies for mental health, developmental disabilities, and substance abuse programs in a timely, cost effective way;
• Establishes a central repository of recipient data across the Division's circle of services and programs;
• Establishes a central repository of provider data across the Division's circle of services and programs;
• Allows the state to more closely monitor the delivery of MH/DD/SA services, and to properly measure and track area program performance;
• Reduces the potential for over-billing and duplicate payments for the same units of service and
• Simplifies the claims filing practices for area programs and reduces the claims payment cycle time.

Resources

• Service Array 2012-2013 (Excel) (4/13)
• DMH Approved Alternative Services - SFY 12 (Excel) (8/27/12)
• Diagnosis/Target Populations Crosswalk (Excel) - (4/13)
• Budget Criteria 2012-2013 (Excel) (10/12)
• Provider Specific Rate Request Form (Excel) (9/09)
• Rate Justification Form (Word) (9/09)
• System Audits Manual (3/13)

Contacts Us

For questions from the public regarding DMH policy and clinical issues: DMH Contact
General Information: Gary Imes
Providers: Please contact your LME for IPRS related questions