Transforming Medicaid Eligibility Through Advanced System Implementation
As healthcare needs evolved across the island, Puerto Rico’s Department of Health launched an ambitious initiative to modernize Medicaid services for 1.5 million residents. To do this, the agency needed technical experts to help launch the RedMane Technology Medicaid Information Technology Initiative Third Generation system, a software solution that improves eligibility and enrollment processes.
On Point Strategy worked with the Puerto Rico Department of Health to test the system, fix issues, and monitor performance during the Medicaid Information Technology Initiative Third Generation (MEDITI3G) rollout and maintenance. OPS handled user acceptance testing (UAT), resolved over 15% of reported issues, and created regular performance reports. These efforts helped keep the system reliable, encouraged users to adopt it quickly, and ensured compliance with federal and state Medicaid rules.
The
Project
MEDITI3G Medicaid Eligibility and Enrollment System Testing and Support
Quick Facts
Project Status :
Location:
Impact:
System:
Client:
Prime:
The project needed a full range of technical services to help launch and maintain Puerto Rico's updated Medicaid system. These services included:
- Designing and carrying out UAT
- Developing and managing test cases in JIRA
- Testing and validating the CÚRAM platform
- Finding, tracking, and fixing system issues
- Monitoring system performance and providing regular reports
- Making sure the system is reliable and runs efficiently
- Supporting users and making sure training matches their needs
- Checking that the system meets federal and state requirements
The
Challenge
When the Department of Health rolled out the MEDITI3G system to update Medicaid services for 1.5 million residents, the agency faced several major technical and operational challenges.
System Complexity
The MEDITI3G platform integrated several modules for eligibility, enrollment, and case processing. This meant the team had to carefully test how these parts worked together to make sure everything ran smoothly from the start.
Anomaly Volume
During and after the rollout, the new system produced numerous reported errors and user issues. These problems were beyond what the internal technical teams could handle, putting user trust and program stability at risk.
Compliance Rigor
Medicaid systems must closely follow federal Centers for Medicare and Medicaid Services (CMS) rules, state laws, and data security standards. This requires thorough checks and clear records for every system function.
User Adoption Barriers
Moving thousands of workers and administrators from old systems to MEDITI3G needed more than just working technology. The new system also had to be easy to use, dependable, and offer quick help with problems to keep staff productive and motivated.
Performance Visibility
Without regular tracking of system performance, error rates, and how quickly issues were fixed, leaders could not see how well things were running. This made it harder to spot problems early and use resources effectively.
The
Solution
On Point Strategy used a thorough quality assurance and technical support plan to help the MEDITI3G system perform successfully.
Rigorous Testing Protocols
We designed and carried out detailed UAT using JIRA to manage and track test cases. This process checked that all Medicaid eligibility and enrollment workflows worked as expected before the system went live.
Platform-Specific Validation
We performed focused testing on the CÚRAM platform to make sure case management, eligibility rules, and enrollment processes worked properly within the full system.
Anomaly Resolution Management
We defined clear steps for finding, sorting, prioritizing, and fixing reported system issues. Our team handled over 15% of all reported problems by finding the root cause, documenting them, and working with RedMane Technology and state technical teams to resolve them.
Performance Intelligence Systems
We created automated reports that regularly tracked important system performance indicators, error rates, resolution times, and user activity. These reports turned raw data into useful information for Department of Health leaders and system administrators.
Compliance Verification Frameworks
We followed testing and validation steps that matched federal MITA standards and CMS requirements. This ensured that the system’s functions, data security, and reporting met all regulatory requirements.
User Support Integration
We worked with training and help desk teams to connect what we learned from fixing issues with user support resources. This helped solve problems faster and reduce recurring issues through focused training.
The
Impact
The collaboration led to more measurable results in system reliability and operational efficiency.
$1.5M
residents served by the modernized Medicaid eligibility system
15%
of reported system anomalies managed and resolved by OPS
100%
UAT coverage ensuring pre-deployment validation
System Reliability
Careful testing and quick responses to issues maintained high system uptime and performance during critical enrollment periods.
User Adoption
Fast problem-solving and performance improvements enabled the team to switch to MEDITI3G quickly, with minimal disruption to productivity during the migration.
Compliance Assurance
We confirmed the system met federal Medicaid rules and state standards, which helps maintain CMS funding and stay ready for audits.
Decision Support
Regular performance reports made it easier to use data for resource planning, spot issues early, and plan for system improvements.
Lasting Value
In addition to system testing and support, On Point Strategy provided lasting improvements that made the project even more valuable.
Institutional Testing Frameworks
The UAT protocols, JIRA test case repositories, and CÚRAM validation procedures set up a reusable quality assurance system. This allows the Department of Health to update the system, add modules, and run regression tests without having to rebuild testing frameworks each time.
Knowledge Transfer and Capacity Building
Working directly with the Department of Health technical staff to resolve issues and analyze performance helped build their skills in system diagnostics, root cause analysis, and issue triage. This developed lasting internal abilities for ongoing system maintenance.
Process Standardization
OPS set up clear processes for categorizing, prioritizing, and resolving issues. This helped the Department of Health handle system problems more efficiently, respond more quickly, improve documentation, and work more effectively with RedMane Technology.
Data-Driven Culture
Regular performance reports helped the Department of Health manage the system using clear metrics. This changed their approach from reacting to problems to focusing on improving performance and planning ahead.
Risk Mitigation Infrastructure
Thorough testing and validation frameworks lowered the risk of major system failures, data problems, or compliance issues. This helped protect the Department of Health from audits, funding problems, and service interruptions for 1.5 million Medicaid beneficiaries.
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