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    Office of Medical Assistance Program (OMAP)

    Bureau of Data Claims Management

    The Bureau of Data and Claims Management (BDCM) oversees the operational and technical activities related to Medicaid information technology initiatives. This includes Centers for Medicare & Medicaid Services (CMS) funding requests, vendor contract monitoring, and invoice processing for the Medicaid Management Information Systems (MMIS) fiscal agent and several other vendors. 

    BDCM is charged with providing leadership in the support and development of innovative technological solutions to all stakeholders of the Office of Medical Assistance Programs’ (OMAP) healthcare programs and supports the Transformed Medicaid Statistical Information System (T-MSIS) reporting to CMS to ensure OMAP’s enhanced federal funding rate. BDCM is responsible for operational support of the MMIS and associated system enhancements to support all federal and state regulations, mandates or program changes, while ensuring efficient and accurate processing of claims and data. 

    BDCM also provides operational and technical support for the managed care program, case management and prior authorization for Fee-for-Service (FFS) programs, the Fraud, Waste and Abuse system used by the Bureau of Program Integrity, and Electronic Visit Verification (EVV) for both FFS and managed care.  

    Divisions

    This division manages FFS operations, including medical code oversight, claims processing support, financial support for claims payment and gross adjustment, and eligibility verification processing. In addition, this division oversees managed care operations, which support the technical interaction with the managed care organizations and with the Office of Income Maintenance (OIM).

    • Division Chief: Sarah Bjorkman

    This division is responsible for identifying the module MMIS system requirements during the MMIS Modernization and is responsible for system enhancements needed to support all federal or state regulations or program changes.  In addition, this division supports data gathering (EDW), which includes performing data extracts, and data analysis needed to support DHS activities.

    • Division Chief: Keith Weidner

    This division is responsible for developing and submitting Advance Planning Documents to CMS and tracking of the enhanced federal funding initiatives. In addition, this division must monitor, track and project the state and federal budget and funds for MMIS related activities and ensure vendors are meeting their contractual obligation: and is the lead to identify requirements and priorities with the MMIS vendor and BIS on the CMS mandated T-MSIS reporting.

    • Division Chief: Toni Hoffecker

    Bureau Information

    Director

    • Sandy Marcella, MPA

    Contact Information

    • Address: Harrisburg Uptown Building, 2nd Floor, Suite 260
      P.O. Box 2675
      Harrisburg, PA  17105 
    • Email the BDCM Support Unit: RA-pwbdcmsptu@pa.gov