Gainwell has a long history and proven reputation for its ability to build common solutions that support federal legislation mandates — as evidenced by our position as the No. 1 Medicaid provider, currently supporting 31 states and territories. We have always been strong proponents of creating repeatable solutions and platforms that can be leveraged to benefit our clients by reducing development time and lowering the cost to deliver new services and capabilities.
One of these solutions is a software application referred to as MAPIR, the Medical Assistance Provider Incentive Repository. MAPIR embodies the Centers for Medicare & Medicaid Services’ (CMS) vision for collaboration, cost sharing, and coordination in administering the electronic health records (EHR) incentive program.
Sharing costs and reducing effort
MAPIR’s origins go back to 2009, with Federal passage of the 2009 Economic Recovery and Reinvestment Act. Working with 13 states led by the Pennsylvania Department of Public Welfare (DPW), we developed MAPIR to administer the Medicaid EHR Incentive Program (now identified by CMS as the Promoting Interoperability Program).1 A 14th state was added to the consortium of states in 2015. These states work in partnership for the successful operation of MAPIR. MAPIR continues to successfully comply with federal regulations and to minimize the operational costs associated with administering the Medicaid EHR incentive program.
MAPIR is an example of “good government at work.” Its success reflects 14 individual states’ decision to unite to gain business efficiencies, share costs, learn from each other and coordinate the administration of an important federal program. The MAPIR Collaborative received the National Governors Association’s Public-Private Partnership Award in 2012.2 The program issued more than $1.5 billion in incentive payments to providers across the country.
Integrating and leveraging a state’s investments
The MAPIR application is highly modular and integrates with the provider portal, intranet and nightly processing capabilities of an existing Medicaid Management Information Systems (MMIS). As specific state implementations of the program vary widely from a policy standpoint, MAPIR provides extensive configurability and customization options.
Under the direction of the Collaborative, a core team designs and delivers the core solution, which is then integrated into the state’s secure provider portal and financial system. After integrated, MAPIR guides providers through attestation, calculates payment amounts, and supports administrative governance and payment determination by program officials. MAPIR also supports workflows associated with confirming professional provider and hospital eligibility, attestation requirements, suspense processing, meaningful use criteria and data exchanges with CMS.
Reaping the benefits
By participating in the MAPIR Collaborative, Gainwell’s clients experience numerous benefits, including the ability to:
- Significantly reduce expenses by using one core system that distributes costs among participating states
- Share knowledge, best practices, oversight and input for ongoing application development
- Collaborate to ensure MAPIR meets statutory and regulatory requirements and minimize the potential for fraud, waste and abuse
- Discuss operational issues and incentive program implementation strategies with representatives from other state Medicaid programs, reducing overall effort for states
- Leverage existing MMIS infrastructure to further reduce costs
- Make required updates in an efficient and cost-effective manner to support future meaningful use requirements
Providing form and functionality
MAPIR was developed as an open source, modular offering based on Medicaid Information Technology Architecture (MITA) principles. It integrates with an existing state provider portal, provider data, financial system, and claims or encounter data sources to support incentive payment application processing.
MAPIR provides wide-ranging functionality, including:
- States can obtain the core MAPIR system and run it on their own at no additional cost — it uses service-oriented architecture and received federal funding for development costs.
- Creates outbound transactions to the Medicare and Medicaid Program Registration and Attestation System (R&A) and receives and processes incoming transactions received by the state. These transactions support eligibility determination, payment history, sanction inquiry, cost reports and attestation data for dually eligible hospitals.
- It integrates into an existing provider portal, enabling authorized providers to register, view and confirm their R&A registration information. Providers can also attest to adopt, implement, upgrade or meaningful use status, and submit patient volumes and meaningful use data through an online application process.
- Dynamic navigation functionality enables accurate collection of attestation information based on provider responses, overall provider progress level in the incentive program, and appropriate regulatory requirements for the program year.
- MAPIR receives resulting payment remittance information — such as transaction number and payment date — from the MMIS or designated financial system and reports this information to the CMS R&A.
- A real-time interface to the Office of National Coordinator Certified HIT product list is available to verify the use of a certified EHR technology product entered by a provider.
- State-specific data — such as summarized claim data and hospital cost reports — is received by MAPIR from the state MMIS for review by the internal state users for validation against provider-submitted data.
- States can define a customizable online questionnaire to collect HIT data from the provider prior to application submission.
- MAPIR generates multiple daily and weekly reports to assist with application processing and inventory tracking by state program administrators.
Achieving value through collaboration
Clearly MAPIR reinforces the many advantages of states sharing ideas, collaborating on system and program development and creating efficiencies to better use limited resources. This directly aligns with the CMS Leveragability Standard.
Ongoing development of MAPIR is guided by a formal governance structure led by Pennsylvania, with representatives from each participating state and Gainwell. This will ensure the system continues to meet evolving Federal guidelines and Medicaid EHR Incentive Program requirements.
1 MAPIR was initially developed by the Enterprise Services business of Hewlett Packard, which merged with CSC in 2017 to create DXC Technology, which spun off Gainwell Technologies.
2 “States Coming Together to Implement Medicaid EHRIPs,” Vermont Official State Website, https://healthdata.vermont.gov/ehrip/Mapir