Puerto Rico Department of Health
Puerto Rico Medicaid Management Information System (PRMMIS) Transforms Medicaid Agency into Information-Driven Enterprise
The Federal Government’s Centers for Medicare and Medicaid Services (CMS) strongly recommends that U.S. states and territories adopt a Medicaid Management Information System (MMIS) for processing, managing and reporting local Medicaid-related activities. This allows them to provide operational and reporting excellence across agencies, and implement internal controls to reduce waste, fraud, and abuse in the healthcare system.
It was considered so important that CMS offers monetary incentives for regions that conform. As one of the last territories to adopt an MMIS and modernize its Medicaid program, Puerto Rico was in danger of losing $1.2 B in disaster relief funds, which had been frozen because of non-conformance.
Taking the first step toward modernization of its Medicaid system, the Puerto Rico Department of Health rolled out the first module within its Puerto Rico Medicaid Management Information System (PRMMIS) in March 2018. Key capabilities within the first module include: Managed Care Organization (MCO) claims and encounter submissions and processing, monitoring and reporting of services provided, statistical analysis of treatment patterns, analytical reporting, and federal reporting for the T-MSIS file submission.
After the new system was developed and implemented by DXC Technology, the department turned to Wovenware to develop the interfaces that would enable effective transfer and reporting of Medicaid data in HIPAA -compliant format through an Electronic Data Interchange (EDI).
Wovenware Interfaces Allow Data Transfer Between Local Agencies and Federal Government
Key Business Benefits
With the new PRMMIS and its interfaces that enable seamless data integration, the Puerto Rico Department of Health will be able to achieve compliance with federal requirements and receive $1.2B in federal reimbursement for Hurricane María disaster relief efforts, as well as access to additional funding in the future. Other benefits include: