WDH 1-11-22
The Wyoming Department of Health (WDH) is nearing the end of an innovative, major, multiyear effort to improve and modernize key technology systems used by the department, healthcare providers and program clients across the state.
WDH directly administers Wyoming Medicaid and Wyoming Kid Care CHIP, the state’s children’s health insurance program, providing health and long-term care coverage to low-income children, parents, seniors and people with disabilities. Approximately $550 million in claims are paid each year to healthcare providers for services and care of program clients.
The modernization effort, called Wyoming Integrated Next Generation System (WINGS), involves replacing systems through the procurement and installation of eight component modules: provider enrollment, claims processing, data warehousing, reporting, program integrity, pharmacy benefit manager, provider call center, third party liability, system integration, electronic visit verification and care case management.
“Several years ago it became quite clear we needed to replace our outdated technology, which was inefficient to modify and had high maintenance and operation costs,” said Teri Green, state Medicaid agent and the Division of Healthcare Financing senior administrator with WDH.
Rather than replace the existing large and complex system with another similar system, WDH decided to bid out components separately. “We did not want to find ourselves with a giant system that needed total replacement again in a few years. Our approach allows us to work with specialized vendors on the things they do best and allows for more ongoing updates,” Green said.
Green noted the typical “big-bang approach” had a history of problems, cost overruns and delays in other states. “That was something we wanted to avoid,” she said.
With an overall budget of roughly $77 million, the WINGS effort has been paid for with federal money at 90 percent matching rates, with the state funds representing 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 begins next month and care case management is currently in procurement planning.
Designed to reduce the administrative burden on medical providers and lower costs for the state, the recently completed Medicaid Benefit Management System (BMS) project is the largest WINGS module. The BMS system replaced Wyoming’s legacy Medicaid Management Information System, which had been used since 1993 as the financial and accounting system for paying medical, dental, vision and waiver provider claims.
Jesse Springer, Medicaid Technology and Business Operations Unit manager with WDH, said there are several benefits to the state due to the new components. “With the new BMS system specifically, ongoing programs and federal and state legislative changes in healthcare policy will be delivered more effectively and efficiently to clients,” he said. “Wyoming providers can also now enter claims for payment processing in real time, allowing for quick corrections.”
“Putting this new WINGS system in place required hundreds of thousands of hours of state staff time over multiple years for procurement, contracting, design, development, implementation, testing and stabilization,” Springer said. “State staff took on project duties in addition to their normal jobs, and we thank each of them for the personal sacrifices and dedication that made this possible. The complexity and scope of the project took a true team effort working with vendor staff and other partners.”
Technology, operations and consulting vendors 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 state government partners include the Department of Family Services, Department of Workforce Services, Enterprise Technology Services, the State Auditor’s Office and the Governor’s Office.
Jan Stall, Provider and Benefit Management Unit administrator with WDH, said, “As with the implementation of all complex technology projects, some issues are expected as we work with them over time. Our department is committed to making necessary corrections and enhancements.”
Wyoming Medicaid or Kid Care CHIP members experiencing issues should call (855) 294-2127 and select the most relevant option. Members may also email janet.reifschneider1@wyo.gov and ruth.jo.friess@wyo.gov if additional help is needed. Providers with questions or issues can contact Provider Services at 1-888-WYO-MCAD or Wyproviderservices@cns-inc.com. Providers may also email nora.huvane@wyo.gov and karen.small@wyo.gov for more help.