Claims Management System

State of Maine

Challenge

The State of Maine’s Office of MaineCare Services (OMS) Claims Management System (MECMS) was plagued by numerous issues. MECMS issues impacted OMS operations as well as significantly impacting the State’s general health care system and program Members.

Value Delivered

NCG helped design and implement emergency fixes and workarounds to address production problems with MECMS. NCG worked with OMS personnel to identify and program specific fixes for the system based on technical and process level analysis and assessments.

NCG worked with OMS staff to model current MECMS processing that were causing problems and was compared to the desired results. NCG helped OMS identify fixes to the existing automation, as well as process level actions that could be implemented manually.

NCG provided direct technical interface and communication with the Provider community in Maine as well as other external interest groups. NCG supported communication and training efforts with internal staff was well as key external staff that helped test and evaluate fixes and work-around measures.

Results

NCG worked closely with OMS staff to help define and implement fixes or training in workarounds as the original vendor tried to address numerous deficiencies in MECMS.

NCG delivered expertise in regulatory provisions and the application of HIPAA considerations—covering business and automated processes. NCG brought a combination of technical expertise along with structured assessment frameworks for root cause analysis to organize issues and mitigation strategies.

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