1. How important are information systems for Maine's Department of Health and Human Services? Analyze the impact of its faulty Medicaid claims processing system.
Information systems are critical to Maine's Department of Health and Human Services. Its new Medicaid claims processing system was rejecting claims much more frequently than its old system had. Due to the rejected and frozen claims, the Bureau of Medical Services could not keep up with the processing and number of phone calls in relation to these claims. Some of the Medicaid providers were forced to turn away patients and even close operations because they were not compensated properly. Several others had to seek financing to maintain operations. Maine's finances became threatened as well due to the large segment of the state budget that Medicaid had in the past. The system created overpayments totaling $9 million. This huge disaster cost the state millions of dollars to fix. Maine became the only state not to satisfy the HIPAA requirements.
5. If you were in charge of managing this project, what else would you have done differently to increase the chances for success?
Well I wouldn't have implemented a brand new information system or I would have only went with a designer that already had created a similar successful system for another state. Considering the time constraint and lack of knowledge in creating such an elaborate system, I wouldn't have taken this risk. If it had been decided to create a new system, I would most definitely have done things differently. I would have appointed a Medicaid expert to work with the designer full-time from the beginning. Communication between the designer and Medicaid team would be highly emphasized. I would have also created some sort of online training session for providers to learn how to fill out the claim forms correctly. This would have greatly reduce several of the claim rejections.
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