Modernizing Solutions 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

Building it Right

Wovenware creates the data interchange interfaces to meet critical guidelines:

  • Each interface is HIPAA compliant and contains advanced security features. Wovenware deployed a proprietary tool to automatically run interfaces and provide management oversight through dashboards and alerts.

❝Conformance to reporting guidelines results
in $1.2B in federal reimbursement❞

Let’s create useful technology together that empowers humans and delivers impact.