Our Work - Puerto Rico Department of Health

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

 

OVERVIEW

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 $1.2 B in disaster relief funds, which had been frozen because of non-conformance. 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).

 

 

PRMMIS Picture

Roles

  • Project Leadership
  • Business Analysis
  • Software Architect
  • Software Engineer

Deliverables

  • Business Requirements Documents
  • Architecture Design
  • Eight (8) Interfaces
  • Oversight and Management Dashboard
  • Technical Documentation
  • Test Plan
  • Training to End Users
THE CHALLENGE

What We Faced

  • 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 in multiple formats
  • Enable transparency of internal activities to allow adequate administration of the back-end processes that feed the new system

Overcoming challenges

OUR APPROACH

How We Helped

Wovenware developed 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 deployed a proprietary tool to automatically run interfaces and provide management oversight through dashboards and alerts.

Technologies

  • Java

    Java

  • Restful

    RESTFul APIs

  • Spring

    Spring Framework

  • MySQL

    MySQL Database

  • Angular

    Angular Material & AngularJS

  • Bootstrap

    Bootstrap

RESULTS

Client Success

The successful implementation of the new solution enabled access to $1.2 billion in Disaster Relief Funds that were allocated to the Island after Hurricane Irma and Hurricane María devastated it in 2017. The system enhances efficiencies, transparency, and accountability of Puerto Rico’s Medicaid Program by implementing internal controls to reduce waste, fraud, and abuse in the healthcare system.