client: A LEADING HEALTHCARE COMPANY
VERTICAL: HEALTHCARE
PRACTICE: BPM - PEGA
Project
Utilization Management (MMP)

This leading healthcare company focuses on providing government-sponsored managed care services through Medicaid and Medicare Plans to families, children, seniors and individuals with complex medical needs. The MMP Project (Medicare Management Platform, a multi-million dollar Pega Program in WellCare) is responsible for achieving this goal through their patient service applications which include workflows for Inpatient and Outpatient Admission which determine the member eligibility, need for an authorization and the associated reviews while staying compliant to the CMS guidelines.

Maantic was involved in the following:

  • Application maintenance and enhancements
  • Customized Care Management FW to suit WellCare requirements
  • Building Prior Authorization functionality in MMP application
  • Refactoring existing MMP application.
  • Upgrading applications to Pega 7.2
  • Integrating with multiple in-house systems
  • Providing technical expertise and ownership of technical solutions
  • Tuning system architecture and optimized code for performance improvement
  • Preparing design documents, production roll out model, transition documents, training plans
  • Providing application training for end users
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