PRMMIS 834 Project Brief
Medicaid Eligibility determination (270/271) + Affiliations and maintenance (834)
OBJECTIVES:
The main objectives of implementing X12 834 include standardizing enrollment processes, enhancing data security, and facilitating interoperability among different healthcare systems.
The following are cited as project reasons stated by PRMMIS/ASES in the projects meetings:
* Standardize the process (across PRMP, ASES, and all trading partners)
* Become HIPAA compliant.
* Eliminate potential points of failure and other errors.
PRMMIS 834 Project
Implementation in MCS of the PRMP X12 Standard 834 and 270/271 transactions processes and files for the Medicare Platino Population substituting previous ASES Eligibility proprietary files, processes and reports.
Project Strategy for Compliance while being built:
* Initial Compliance phase Nov 2023: Manual processing
* Automation of the manual processing
* Web application user interface
* Reports and dashboards
STAKEHOLDERS
Project Sponsor: Rosadaliz Berríos
Project Owner: Héctor Ríos
LOB: Medicare Platino dual eligible
Operation Segment: Medicaid Eligibility and Affiliation
Opportunities:
* Process Improvement
* EDI Standard, HIPAA compliance
* Data discrepancies reduction
Current Project Status:
Expected Outcomes:
- Project in production by regulatory agency PRMP since Novembre 2023.
- Project scope defined, Project Charter signed
- Project initial timeline impacted.
- Project delayed, new IT Date is November 2024.
Database, information systems, EDI processes and reports to manage:
* Outbound 270 to ask for Medicaid Eligibility
* Inbound 271 response to 270
* Outbound 834 Medicare Platino enrollments and maintenance.
* All supporting database, information systems, user interfaces, reports and dashboards
Challenges, Risks and Issues
- Continuous requirements changes
- Production and development issues intertwined
- PRMMS changes in production without heads up or information
- Platino enrollment discrepancies between MCS, ASES, CMS and PRMMIS cause extra reconcilitation work and loss or delay in capitation income
- First time 834 project implemented in MCS, no previous experience or background
- MCS IT Development tasks durations and new tasks introduced to the plan without due project change management
- Delays in MCS final solution complicates project progress because Enrollment needs IT support for operational tasks
LESSONS, TIPS and TRICKS:
LESSON: In these regulatory projects, even though requirements are draft, MCS needs to work sooner and faster to comply.
GOOD: After escalation, IT Development contracted additional consultants for this project to speed it up.
TRICK:
- Escalation to Intervoice for more formal project support after go-live.
- Aracelis Morales’s experience, lessons, and recommendations from similar projects with ASES & PRMMIS.