Healthcare │ Software Development

P.R. Medicaid Qualifies for $1.2 Billion in Federal Reimbursement

Wovenware creates a solution to help Puerto Rico Department of Health comply with federal requirements for Medicaid data reporting in HIPAA-compliance format

“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.”

Identifying opportunities together

The Puerto Rico Department of Health rolled out the first module within its Puerto Rico Medicaid Management Information System (PRMMIS) in March 2018. As one of the last territories to adopt an MMIS, Puerto Rico was in danger of losing access to $1.2B in disaster relief funds from hurricanes Irma and María, which had been frozen because of non-conformance.

Setting a goal for success

After selecting an MMIS system developed by DXC, the department turned to Wovenware to develop the data interchange interfaces that would enable effective transfer and reporting of Medicaid data in HIPAA compliant format through an Electronic Data Interchange (EDI)

Our challenges and learnings

  • The need to comply with federal reporting requirements and gain access to future financial incentives through a modernized MMIS system.
  • Ensure data sharing in a uniform HIPAA compliant and DXC-compatible format across a very complex Medicaid system with multiple local agencies storing patient data.
  • Enable transparency of internal activities to allow adequate administration of the back-end processes that feed the new system.

The Wovenware Approach

Wovenware developed eight interfaces to effectively clean and transfer all the needed data from various agencies — from member eligibility and provider enrollments, to information related to provider and managed care payments — to DXC for uploading to the PRMMIS.

Technologies we take advantage of