Maines Medicaid Mistakes

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Maine’s Medicaid Claims Processing System

Maine’s Medicaid Claims Processing System: A Case Study about the Project Management Mistakes and Pitfalls

Eric Sissom

UNIV 4706 Managing Software Development, Section R50-M08C Professor Schaeffer August 9, 2008

Maine’s Medicaid Claims Processing System:
A Case Study about the Project Management Mistakes and Pitfalls
In the beginning of the year 2005, the state of Maine eliminated the old Medicaid claims processing system for a new web enabled, more secure, and faster system. This new system was $25 million and created a lot of problems for the state of Maine, doctors, hospitals, and patients. This analysis will discuss these problems and mistakes that were made as well as solutions that would have helped the situation in a desperate time.
Maine had two bids for the project. Those were from Keane for $30 million and CNSI for $15 million. Keane had some experience in developing Medicaid systems while CNSI had no experience. Usually, organizations want to receive several bids within a close range. Since they only received two bids, this should have raised a clue that the requirements of the project were unreasonable. There first mistake is not revising the requirements in hopes of getting more bids. There second mistake is accepting the bid from CNSI because they had no experience with Medicaid systems.
The likely cause of the project failure started from the beginning when CNSI and Maine’s Department of Human Services (DHS) IT staff could not meet with Medicaid experts to discuss the Medicaid rules. Instead, CNSI contractors had to decide how to meet Medicaid requirements. Then they had to redo their code after consulting a Medicaid expert, which slowed development.
Jack Nicholas was the…...

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