The Puerto Rico (PR) Medicaid Enterprise is in the process of a major transformation of the systems that are used to support the operations of the enterprise. The Design, Development and Implementation (DDI) Phase for the PR Medicaid Management Information System (MMIS) commenced in late October 2016 with CMS approval of the contracts, for the supporting contractors as authorized in the Implementation Advance Planning Document Update, approved by CMS on June 29, 2016.
PlanIT Group’s Doug Mitchell joined the PRMMIS project as PMO Program Director in March of 2017, and is bringing on additional Subject Matter Experts to support PRDoH (Department of Health).
“Because of the lack of enhanced Federal funding authorization to support a fully functional MMIS for the Territories, it was cost prohibitive for PR to consider implementation of an MMIS until funding became available,” stated Doug Mitchell, SVP of PlanIT Group. The challenge for PR is to maintain the current operation and support, a stepwise MMIS implementation approach. There is limited organizational capability for large scale system development, implementation and operations. The PRMMIS project is replicating the proven Florida Medicaid system (a version of DXC’s interchange platform), importing existing PR MCO (Managed Care Organization) data and transitioning the MCO claims and encounter data submittal to the standard, 837 HIPAA compliant format through EDI (Enterprise Data Interchange). The system will roll out in two phases- Module 1 (Ad hoc and Federal reporting and fraud, waste and abuse management) and Module 2 the remainder of the provider, member, and claims processing system. Implementation of Module 2 functionality will be prioritized based on the needs of the PR’s evolving Medicaid department.
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