• 5.31.2023

    Puerto Rico’s Medicaid Eligibility and Enrollment Solution Receives Federal CMS Certification

    San Juan, Puerto Rico – RedMane Technology LLC, a Chicago-based software solutions and systems integration firm, announced today that the Medicaid eligibility and enrollment solution it designed, developed, and implemented for the Puerto Rico Department of Health received full certification by the Centers for Medicare & Medicaid Services (CMS).  CMS is part of the United States Department of Health and Human Services (HHS).

    “Achieving independent and objective federal certification is a testament to the tireless work of Puerto Rico’s Department of Health to provide world-class service and care to its citizens”, Said Carlos Mellado López, Secretary of Health. “This significant milestone demonstrates the incredible progress the agency has made in transforming its systems and operations to better meet the needs of those it serves”.

    CMS conducted a rigorous and comprehensive assessment of Puerto Rico’s system and functionality using an Outcomes-Based Certification (OBC) process.  Based on meeting the assessment’s exhaustive criteria, CMS granted full certification retroactively to Puerto Rico’s initial 2021 implementation date.  As a result of certification, Puerto Rico will receive additional funding to help its most vulnerable populations.

    Cloud-based Solution Improves Citizen Service and Enables Expanded Healthcare Access

    The Department began the eligibility and enrollment system implementation project in 2019, continued the work during the pandemic, went live with the solution in 2021 to over 800 staff, and has been continually enhancing it to deliver more features.  The modern, cloud-based solution includes a citizen-facing web portal, secure integration to federal and territory systems, a rules-engine, automated change in circumstance processing, and bi-lingual support through the application.

    “We are grateful to have received CMS certification,” says Rafael Graulau Reyes, Medicaid Enterprise Systems Program Manager for the Puerto Rico Department of Health. “It recognizes the great work of our staff and our partner at RedMane in implementing new processes and technology that improve citizen service, expand health care access, and streamline departmental processes.  Our work continues as each day we are adding further capabilities to the system to better serve our citizens.”

    About the Puerto Rico Department of Health

    The Puerto Rico Department of Health’s mission is to promote and preserve health as an essential condition in humans to enjoy from physical, emotional, and social wellness, and thus contribute to the society with their productive and creative effort.  Puerto Rico’s Medicaid Program is administered by the Department of Health, operates 66 local offices, and uses a managed care approach for healthcare service delivery. To learn more about the Puerto Rico Medicaid Program, visit medicaid.pr.gov.

    About RedMane

    RedMane provides software solutions and systems integration services that address complex, real-world challenges.  Our health and human services expertise includes eligibility and enrollment, case management, child welfare, and child support.  We are a problem-solving company and technology is just one of our tools. To learn more about RedMane, visit redmane.com