South Dakota set to modernize 30 year-old Medicaid tech

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South Dakota awarded a contract worth an estimated $67 million to replace its 30-year-old legacy Medicaid Management Information System (MMIS) with a Web-compatible platform. The deal went to CNSI, a Rockville, Md.-based software services firm, for its eCAMs solution, which features a Web-centric architecture, rules engine-based processing and is aligned with the Medicaid Information Technology Architecture (MITA) framework. "You're talking about the difference between 2008 technology and 1978 technology, so it will be a huge change for us, " said Rodger Leonard, MMIS Project Director for the South Dakota Department of Social Services (DSS). "The benefits we expect in terms of efficiency, flexibility, cost savings and our ability to respond to changes in federal and state regulations are pretty significant." Those benefits include faster and more reliable claims adjudication; improvements in payment accuracy, customer service and fraud prevention; real-time online access for providers who need to determine claim status; and the ability to perform analytics and disease management. Leonard noted that the new system will be flexible enough to more easily incorporate state and federal programmatic and policy changes, as well as quickly generate non-standard information and reports. A modernized MMIS will also have positive ramifications for South Dakota's 102, 000 Medicaid recipients, which are served by 11, 000 providers across the state. "A more efficient, effective and economical Medicaid program definitely has the potential to improve health care outcomes, as well as assist us in managed care and disease management, " Leonard said. He noted that both Medicaid members and providers were often frustrated in the past by a severe time lag that existed between the eligibility determination process and when that information was available in the MMIS system. That information will now be available in near-real-time. CNSI and DSS personnel are currently going through a review process before beginning a validation of the 3, 500-plus requirements outlined in the two-year-old Request for Proposal. The project, which will receive 90 percent of its funding from the Centers for Medicare and Medicare Services (CMS), is scheduled to go live in late 2010.