Demystifying Modular Medicaid Implementations

In 2015, the Centers for Medicare & Medicaid Services (CMS) ushered in sweeping changes to the rules governing the funding of Medicaid Enterprise Systems (MES). Its goal was to incentivize states that leverage advanced technologies for modernizing archaic MES systems.

It was immediately welcomed as it broke down the legacy barriers to entry, preventing innovators from developing and bringing advanced solutions to the Medicaid market.

This move was beneficial for state agencies to automate outdated manual processes and paved the way for a more connected, standardized, and scalable MES ecosystem that assures accurate, timely, and consistent results.

Trinisys helps state Medicaid programs seize this opportunity by enabling them to build rapid, reliable, and modular MES solutions.

Trinisys is well-suited to facilitate this paradigm shift as it leads the charge of e-governance for the nation’s leading healthcare, government, and Medicaid organizations. It owes this success to its core platform, Convergence.

Built with client’s complex environments in mind, Convergence incorporates a suite of low-code tools that modernize internal processes, eliminate inefficiencies with automation, and customize data prioritization and presentation with detailed reporting functionality.

Its data aggregation solution helps solve major data integration and interoperability hurdles. The platform’s robust integration engine bridges the gap between systems to keep vital data flowing securely and efficiently within and between organizations. They can easily streamline timeconsuming, repetitive, and tedious work while saving time and money.

Over the years, the platform has grown to include a great deal of automation capabilities structured around many business processes of different government agencies requiring workflow coordination.

“Convergence is creating a new wave by optimizing workflow orchestration for secure processing of all tasks related to contract compliance,” says William Bartholomew, CEO of Trinisys.

Its contract compliance workflows facilitate ease of interaction between different participants in the process, allowing clients to design custom contract workflows that regulate the tasks involved in submitting, reviewing, collaborating, and ultimately approving contracts in a standardized way.

Customer centricity is another major differentiating factor. Trinisys has a lot of experience making e-governance easy for its clients via custom-built, user-friendly tools. Trinisys takes extra measures to set things up specifically for each client, as workflow differs from state to state. It goes a long way in driving their efficiency and revenue.

“At Trinisys, we are more than a development team. We are a technology advocate for your business, integrating your ambitions into ours. We pride ourselves in proactively listening to your unique requirements, which allows us to build game-changing software with a high business benefit,” says Bartholomew.

At Trinisys, we are more than a development team. We are a technology advocate for your business, integrating your ambitions into ours

One of its clients is TennCare, a Medicaid program in Tennessee that offers medical care to about 1.5 million citizens.

TennCare’s Office of Compliance Management (OCM) had to ensure all managed care organizations (MCO) provided timely reporting on different contractually required tasks. The OCM team had a solution in place, but it was restricted in functionality, was difficult to maintain, and had an obsolete user interface.

Trinisys created the TennCare Oversight Processing System (TOPS) to address these challenges. TOPS is built on the Convergence platform, updated with improvements, enhancements, and upgrades. The system benefited users in navigating complicated internal and external workflows by providing role-based views, complete audit capabilities, and workflow history. It also came with a convenient portal for deliverable uploads, easy access to deliverable targets with reminders, and an enhanced notification system with email notifications, in-app alerts, and automatic deliverables. This enabled users to process massive volumes of data, resulting in improved data validation and accuracy.

These success stories reveal that when it comes to delivering efficient citizen-centric e-governance services to their doorsteps, Trinisys is always at the helm.