Healthcare │ Software Development

Cloud-Based Data Verification System Powers Medicaid Eligibility Renewals for 1.5 Million Citizens

Wovenware teams with Medicaid to develop automated solution to determine eligibility ofover 1.5 million citizens, while complying with federal regulations.

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“Wovenware has a track record of experience in the industry. They work in a true partnership model centered on achieving project goals.”

Identifying opportunities together

Good healthcare is critical to successful communities, but confirming Medicaid eligibility for beneficiaries and complying with federal mandates can be challenging. Teaming up with Wovenware, Puerto Rico’s Medicaid program was committed to improving the citizen experience for 1.5M participants via automated systems that speed up processes, enable better data collaboration and more efficient and accurate service.

Setting a goal for success

Puerto Rico’s Medicaid Program turned to Wovenware to build a State Hub to automate data verification services for 1.5 million of its citizens while complying with federal regulations to facilitate the eligibility process.

Our challenges and learnings

  • Automate data verification services from eight government agencies required for Medicaid eligibility applications, enabling the implementation of auto-renewals and real-time eligibility determinations.
  • Build a State Data Verification Hub, similar to the Federal Hub that connects to the PR Government data sources needed to validate Medicaid application information for income, tax status, demographics, etc.
  • Comply with federal and HIPAA regulations, as well as PUB 1075 and MARS-E Security standards to protect the privacy, security, and integrity of citizen data.
  • Provide reliable 24/7 backend services for the new Medicaid System (MEDITI3G), allowing 1.5M citizens to securely and efficiently validate their eligibility determination in affordable health coverage.
  • Design an architecture that can support over 300K monthly transactions with 8 different local Government agencies and can scale and adapt to evolving software needs, quickly integrating new data verification services from multiple government agencies and services).
  • Create a robust and holistic testing plan that includes a CI/CD pipeline, functional testing, integration testing, load testing, and security testing.
  • Implement a Disaster Recovery Plan.

The Wovenware Approach

Wovenware’s project leadership is following rigorous Federal standards in project management, communication, risk management, software architecture design and test plan documentation. We collaborate with multiple government agencies and third parties in a multi-year engagement. The design has been completed and the software is being delivered in phases.

Technologies we take advantage of

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