Project

Stabilization of a failed project/platform and achieving support for the implementation of a new Medicaid Claims System

Challenge

When the State of Maine cut over to its new “MeCMS” Medicaid Claims system in 2005, the system failed to properly process claims, quickly resulting in $300+ million in lost and suspended provider claims and an inability to effectively track and reconcile claims submissions.

Solution

With no clear fall-back solution, the State engaged the Abilis team to stabilize the project and establish formal program, project and systems development methodologies.

Working with the State and its vendor, the Abilis team stabilized the system and supported the State’s process to solicit a new vendor and replace the troubled system.

Today, Abilis has remained a key contributor in both the decommissioning of MeCMS and the current implementation of the new MMIS – providing services that range from provider and police subject matter expertise, to development and testing, to maintenance of the existing MMIS Decision Support System.

Benefits

• Created an environment that allowed claims to be paid and suspended claims to be cleared through the MeCMS platform.
• Allowed the State to pursue acquisition of a new system that is scheduled to go live in March, 2010.

Deliverables

• Implementation of formal Program and Project Management Methods.
• Implementation of a structured Systems Development Methodologies including a release management process
• Implementation of reporting

Technologies and partners

• Oracle PLSQL
• J Developer
• Java
• Mercury Test Director
• SQL Plus
• TOAD
• COGNOS 8

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