Department Nears Completion of Major Technology Project

Department on the verge of completing the major technology project

Department on the verge of completing the major technology project

January 11, 2022

The Wyoming Department of Health (WDH) nears the end of an innovative, extensive, multi-year effort to improve and modernize key technology systems used by the department, health care providers, and program customers across the state.

WDH directly manages Wyoming Medicaid and Wyoming Kid Care CHIP, the state children’s health insurance program that provides health and long-term care coverage to low-income children, parents, seniors and the disabled. Approximately $ 550 million in damages is paid to healthcare providers each year for services and support for program clients.

The modernization measure, called Wyoming Integrated Next Generation System (WINGS), includes the replacement of systems through the procurement and installation of eight component modules: provider registration, claims handling, data warehousing, reporting, program integrity, pharmacy performance manager, provider call center, third party liability, system integration, electronic Visit auditing and nursing case management.

“A few years ago it became pretty clear that we needed to replace our legacy technology that was inefficient to modify and incurred high maintenance and operating costs,” said Teri Green, Medicaid State Agent and Senior Administrator, Health Financing at WDH.

Instead of replacing the existing large and complex system with another similar system, WDH decided to tender components separately. “We didn’t want to find ourselves with a huge system that would have to be completely replaced in a few years. Our approach allows us to work with specialist vendors on the things they do best and allows for ongoing updates, ”said Green.

Green found that the typical “big bang” approach in other states had a history of problems, cost overruns, and delays. “We wanted to avoid that,” she says.

With a total budget of around 77 million US dollars, 90 percent of the WINGS efforts were paid for from federal funds, with government funds accounting for 10 percent. Planning for the project began in 2013 and the first system was installed in 2017. Six of the eight project components are in use; Electronic visit verification starts next month and nursing case management is currently in procurement planning.

The recently completed Medicaid Benefit Management System (BMS) project was developed to reduce administrative burdens for medical service providers and costs for the state and is the largest WINGS module. The BMS system replaced Wyoming’s old Medicaid management information system, which has been used as a finance and accounting system for the payment of claims from medical, dental, vision and waiver providers since 1993.

Jesse Springer, director of Medicaid Technology and Business Operations at WDH, said the new components will bring several benefits to the state. “With the new BMS system, ongoing programs and changes to the law at federal and state level in health policy are made available to customers more effectively and efficiently,” he said. “In addition, vendors in Wyoming can now capture claims for payment processing in real time and make quick corrections.”

“The introduction of this new WINGS system required hundreds of thousands of hours of government employees over several years for procurement, contracting, design, development, implementation, testing and stabilization,” said Springer. “In addition to their normal tasks, government employees also took on project tasks and we would like to thank each of them for their personal commitment and commitment that made this possible. The complexity and scope of the project required real teamwork with the provider’s staff and other partners. “

The technology, operations and consulting providers involved include CNSI Inc., Deloitte, Change Healthcare, HHS Technology Group, Gannett Peak Technical Services, Happy Jack Consulting, Carebridge Health, Optum Health Services, Magellan Health, Nerthus Consulting, Sharp Decisions Consulting, Cedar Bridge Consulting, NTT data and public knowledge. Other partners of the state government are the Department of Family Services, the Department of Workforce Services, Enterprise Technology Services, the State Auditor’s Office and the Governor’s Office.

Jan Stall, Administrator of the Provider and Benefit Management Unit at WDH, said, “As with implementing any complex technology project, we can expect some problems over time. Our department endeavors to make any necessary corrections and improvements. “

Wyoming Medicaid or Kid Care CHIP members experiencing issues should call (855) 294-2127 and select the most relevant option. Members can also send an email and if additional help is needed. Providers with questions or problems can contact the provider services at 1-888-WYO-MCAD or Providers can also send email and for further help.