Data Management

CHALLENGE

The Centers for Medicare and Medicaid Services requires states to adopt a modular approach when implementing or upgrading their Medicaid Management Information Systems (MMIS). This approach has many benefits, but it also brings with it the complexity of managing multiple vendors using different technologies and different data definitions.

SOLUTION

ProCom assisted the state agency from the beginning of the MMIS transformation. This transformation involved coordinating a $1 Billion program over a ten-year period. The program scope includes complete replacement of traditional public health eligibility and claims processing. It will provide a 360-degree view of a Medicaid recipient, including all touchpoints between the individual and the state.

The vast amount of data gathered from multiple sources requires data quality, data integrity, proper storage, usage, and efficiency in every transaction. Our team managed the creation of technical and data standards, support for the state’s vendor negotiations, management of the architectural standards board, and organizational change management, risk management, and timeline management across all the stakeholders.

RESULTS

The program is on track and is delivering the expected benefits. Despite multiple cloud platforms (AWS, Azure, and Oracle Cloud) the solution is processing 100,000 claims per second and managing compliance with over 2000 business rules for every transaction. The improvements in self-serve processing have already reduced calls to the call center.