Wipro helped a Midwestern US State Department of Social Services move to a 99.75% paperless environment for Medicaid claims submission by automating its IT processes
The client is responsible for the Medicaid program in a state that has 890,000 Medicaid participants and 38,000 Medicaid providers, covering hospitals, physicians, pharmacies, clinics and nursing homes.
The client processes 100 million claims, worth $6.3 billion annually, touching about 1 million lives of Medicaid beneficiaries.
The US healthcare industry is in the midst of a seismic change. There is a need for an immediate and substantial investment in IT systems to ensure that those eligible are brought under the Medicaid expansion program in time.
Healthcare reforms have led the public health agencies to use technology innovation. The focus is to support proactive outreach, facilitate Medicaid enrollments through community initiatives and modernize business processes and technology.
The client wanted to upgrade its Medicaid Management Information System (MMIS) that processes Medicaid claims. The objective was to achieve a paperless and automated system for claims processing.
The existing, complex IT architecture was unable to scale to business demands and lacked operational flexibility. Some of the key challenges that the client faced were longer time to process claims that even took up to two days in some instances, an ineffective self-service channel that deterred electronic submission of claims and led to higher call center volumes.
One of the strategic priorities was to modernize the legacy IT system for keeping electronic records of patient profiles. The idea was to implement a flexible and an agile IT system and business service.