State of Alaska - Provider Enrollment Portal

Success Summary

Within 10 months, the Infinite team designed, developed and implemented an online Medicaid provider enrollment portal for the State of Alaska: greatly reducing the use of paper applications while significantly improving operational performance and data quality by incorporating business rules, workflow and data validation functions per business requirements. Additionally, the system's service-oriented architecture was leveraged to exchange provider master data with other State systems.

Business Opportunity

Xerox engaged Infinite to build a web-based application that would enable Medicaid providers to enroll and re-enroll in the State of Alaska's Medicaid program while Xerox resources focused on building their new Medicaid Health Enterprise system. The Provider Enrollment Portal (known as PEP) needed to be a "data cleanup/enrichment" conduit to migrate provider data from the Legacy mainframe MMIS to the new web-based Enterprise system. Therefore, the PEP application and data model would need to stay synchronized with the Enterprise system for eventual data conversion into the new system.

Key Project Objectives -

  • Design, develop and implement a secure, interactive web application with multiple dynamic workflows that steps providers through an online enrollment application while enforcing business rules and data validation requirements in order to display and capture complete and accurate data.
  • Convert provider data from the Legacy MMIS into PEP and provide data cleanup functions for the Fiscal Agent staff to correct bad and missing Legacy provider data prior to the reenrollment phase.
  • Identify and track all Active Legacy Providers through the completion of an electronic reenrollment to validate existing Legacy data and obtain additional provider data required for the new Enterprise system.
  • Process all new provider enrollments through the Provider Enrollment Portal (paper applications only used for approved exceptions) for improved data quality and turnaround time.
  • Provide application review and approval workflow functionality for the Provider Enrollment Unit: along with dashboard reporting and enrollment status tracking.
  • Allow providers and fiscal agent staff to update enrollment information online with the same business rules and data validations as an enrollment.
  • Exchange Provider Master data with other State of Alaska systems (i.e. Meaningful Use Attestation System and SLR and their HIE\Master Provider Index).

Infinite Services

Infinite quickly assembled a small, agile and highly efficient team with a high-level of subject matter expertise working with provider data within payer systems. The Infinite team successfully designed, developed, and implemented the initial PEP release in ten months.

Infinite worked with stakeholders from Xerox and the Alaska Department of Health and Social Services (DHSS) to understand the business requirements and detailed workflows for the online enrollment applications. Additionally, Infinite performed the following services:

  • Worked within the evolving Enterprise system data model to deliver the application and ensure data compatibility with the Enterprise system.
  • Engineered a robust sub-system to support multiple enrollment workflows based on complex business rules that varied across numerous provider types (meta-data driven).
  • Provided ongoing maintenance and support to keep PEP:
    • Synchronized with the Enterprise system development
    • Compliant with Federal and State Medicaid program requirements
    • Continuously improved by incorporating productivity enhancements for the Provider Enrollment Unit
  • Created a provider data cleanup sub-system that allowed the Fiscal Agent staff to correct critical provider data which was bad or missing that included interfaces with an IRS data validation system and an online address validation service.

Opportunity Seized

The Alaska Medicaid Provider Enrollment Portal (PEP) solution successfully achieved the key project objectives.

  • Successfully converted the data received from the Legacy MMIS system into PEP, as well as successfully migrated "clean" provider enrollment data from PEP to the Enterprise system.
  • Reduced paper applications from 100% to less than 1%.
  • Improved data quality – able to enforce business rules and data validations on all enrollments.
  • Enhanced provider satisfaction – providers able to track the status of their enrollments online as well as receive email notifications for key enrollment milestones.
  • Reduced related processing costs with automated data validations/verifications as well as the ability to electronically return enrollment applications to providers for needed updates.

Leveraging the PEP solution, Xerox was able to process and approve over 29,000 provider enrollments in a 36 month period (an average of more than 800 provider enrollments per month):

  • New provider enrollments submitted and approved: > 11,100 provider service locations
  • Legacy provider reenrollments submitted and approved: > 13,500 provider service locations
  • Update enrollments submitted and approved: > 4,300 provider service locations