Our Work - Puerto Rico Medicaid Program

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

 

OVERVIEW

Medicaid is required to annually review their participants’ eligibility, a painstaking process that requires PR citizens to visit multiple government agencies to obtain supporting documentation and certification to justify their eligibility. 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.

 

 

PRMMIS Picture

Roles

  • Project Leadership
  • Business Analysis
  • Software Architect
  • Software Engineer
  • Quality Engineer
  • Cloud Infrastructure Administrator

Deliverables

  • Business Requirements Documents
  • Architecture Design
  • Technical Documentation
  • Test Plan
  • State Data Verification Hub
  • 16 Software Interfaces
  • Automated and Manual Testing
  • Government Cloud Hosting, Administration, and Security Management
THE CHALLENGE

What We Faced

 

  • 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

 

 

OUR APPROACH

How We Helped

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.

 The State Data Verification Hub is built on an Azure Government Cloud tenant administered by Wovenware, which complies with Federal regulations and security standards. The team considered scrupulous security requirements in the architecture design since Day One, including physical, authorization, authentication, transport, encryptions, auditing, alerts and monitoring requirements, and protocols. The application was designed to maximize Microsoft Azure Government capabilities with a serverless architecture that will eliminate maintenance overhead and provide 24/7 services to the Medicaid Eligibility System, therefore assisting over 1.5M citizens. Wovenware is developing 16 batch and real-time interfaces for the following agencies: Dept. of Family (ASUME, ADSEF, ADFAN), Department. of Housing, Department of Health’s Demographic Registry, Dept. of Natural Resources, Dept. of Treasury, Dept. of Labor, Dept. of Motor Vehicles.

Always committed to delivering quality products, the team is following a robust and holistic testing plan that includes automated functional testing, integration testing, load testing, and security testing throughout different phases of the project.

 

 

 

Technologies

  • AzureSQL 1

    Azure SQL Database

  • AzureActiveDirectory

    Azure Active Directory

  • AzureAPI

    Azure API

  • AzureDataFactory

    Azure Data Factory

  • AzureDevOps

    Azure DevOps

  • AzureGovernment

    Azure Government

  • AzureFunctions

    Azure Functions

  • AzureKeyVault

    Azure Key Vault

  • AzureMonitor

    Azure Monitor

  • AzureSecurity

    Azure Security

  • BlobStorage

    Blob Storage

  • LogicApps

    Logic Apps

  • ServiceFabric

    Service Fabric

  • VirtualMachine

    Virtual Machine

  • VirtualNetwork

    Virtual Network

RESULTS

Client Success

Wovenware is currently working on this multi-year engagement, projected to be completed in 2022 with the following results:

  • Improved citizen experience for 1.5M participants with automated processing for Medicaid eligibility purposes.
  • Over 300K monthly transactions processed automatically with significantly reduced in-person visits to government agencies.
  • Freed-up case-workers able to focus on business analysis and on the human side of helping citizens during their eligibility process instead of the administrative burden of manually collecting documents and completing checklists.
  • Significant cost reductions in government operational processes.
  • Improved fraud, waste and abuse prevention with the implementation of multi-layered security that ensure the security, privacy, and integrity of systems and data, compliant with Federal statutes and guidelines.
  • Eligibility of Puerto Rico to receive additional Medicaid funds that require pre-approved projects.
  • Scalable State Data Verification Hub serverless architecture that includes interfaces with additional agencies and may support other interagency verification services in the future.

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