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    Challenges and New Business Opportunities

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    The Puerto Rico Department of Health needed to develop an MMIS to comply with federal reporting requirements, implement program best practices and gain access to future financial incentives

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    The complexity of the Medicaid system – with multiple local agencies gathering and storing patient data in multiple formats – made it difficult to ensure uniformity across systems

    The new PRMMIS system required interfaces that would allow information to be easily sent in a format compatible with the DXC-developed system

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    The new interfaces must allow transparency of its internal activities as to allow adequate administration of the back-end processes that feed the new system.

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    “Our new PRMMIS represents a new era for the Puerto Rico Medicaid Enterprise, allowing us to modernize our reporting and data processes and comply with federal guidelines”

    said Luz E. Cruz, Executive Medicaid Director, the Puerto Department of Health.

    “Thanks to Wovenware’s extensive integration expertise and experience developing IT solutions for healthcare, we are able to effectively ensure a unified workflow between Puerto Rico agencies and the DXC-maintained system for effective reporting, claims submittals and analysis.”

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    Wovenware Interfaces Allow Data Transfer Between Local Agencies and Federal Government

    Adding to the complexity of implementing a new MMIS system, patient Medicaid data is managed and stored for the Department of Health by Puerto Rico’s Health Insurance Administration (ASES). Between ASES, the Department of Health and DXC, which processes and sends claims to the federal government, the data was in a different format than what was required for the new system. Without effective interfaces that would allow data to be shared in HIPAA compliant and DXC-compatible format, the PRMMIS systems would be non-operational.  

    Wovenware was brought on board to develop eight interfaces to effectively clean and transfer all the needed data from various systems – from member eligibility and provider enrollments to information related to provider and managed care payments – to DXC for uploading to the PRMMIS. Each interface is HIPAA compliant and contains advanced security features.  

    Wovenware also provided the Department of Health with the Wovenware Integrator tool, which enables it to automatically run the interfaces and export the data files to DXC for input into the PRMMIS system. The tool provides a web-based log-in so ASES/Department of Health can manage the interfaces automatically.  It also includes modules for reporting, alerts and dashboards to confirm that files were transferred successfully, as well as to receive other notifications.

     

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    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:

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    • More effective collaboration across departments
    • The ability to gain credibility and provide transparency to the U.S. government about how the Puerto Rico Department of Health is managing federal money for Medicaid
    • Reduction of fraud and waste within Medicaid services
    • PRMMIS interfaces and the Integrator tool enable fast and seamless transfer of electronic data and continuous updates that can be managed entirely by the Puerto Rico Department of Health and its departments

     

    With extensive expertise in data integration technologies, as well as more than 15 years’ experience helping healthcare organizations modernize their legacy systems, Wovenware is the proven partner to help companies with their most pressing digital transformation challenges.