Solutions|Medicaid|Interoperability Solutions

Enhance critical data exchange between platforms or devices

Whether you are preparing to update your EDI platforms or replacing them to conform to new federal interoperability standards, we can help you.

SaaS solution for enhanced ROI and adaptability

Medicaid agencies are preparing to update their EDI platforms — or replace them — to conform to new federal interoperability standards. In many cases, current EDI platforms won’t support the CAQH Core IV and V requirements or next version of X12 when it is adopted, given the substantial system updates that will need to be made to accommodate mandate requirements. Agencies that can show that their existing systems aren’t up to new demands will benefit from CMS paying for a new solution at a 90 percent match and allowing up to 2 years to move to another system.


There’s an opportunity now for you to transition to Gainwell Electronic Data Interchange as a Service. Our EDI system not only supports the HIPAA standard’s requirements but will deliver greater return on investment and enhanced adaptability than your current solutions. It streamlines updates in a changing environment by supporting multiple standards — such as the current 5010 and future X12 versions — in the same platform with a single instance. There’s no need to duplicate platforms to support diverse standards.


Our solution’s alignment with HIPAA standards for interactions among trading partners, including health providers and health plans, is critical, as penalties have begun to be applied for non-compliance. We also support T-MSIS, enabling your data to be loaded into standard common solution tables, then unloaded, edited and output in the CMS-required format. We perform comparative analysis on the X12 TR3 guides to provide you with early guidance on potential high-impact changes as a no-cost upgrade.


We offer an important alternative to current systems and methods states use to manage Medicaid interoperability services. Our public cloud-based, EDI SaaS system not only supports new HIPAA standard requirements but will improve efficiency, business continuity and customer service while reducing client spend.

Provide a mobile gateway for your members

Every month, on average, your enterprise issues tens of thousands of plastic ID cards and sends thousands of physical mailings to program members. We offer a new and better solution — the Mobile Digital Platform. Our platform provides an innovative, secure digital ID solution at a lower cost.

The Gainwell Mobile Digital Platform is a mobile and web-based solution that supports your digital transformation by reducing or eliminating plastic ID cards and the physical mailing of documents. Mobile Digital Platform displays an exact digital representation of an ID card on a mobile device, smartphone or computer. This is a true COTS product supported with periodic releases.

Mobile Digital Platform is a lightweight app that launches quickly. Its intuitive design makes it easy for members to quickly and securely view their digital cards. An offline mode enables the user to view the digital card and content when there is no internet access. Once internet access is available again, the app refreshes content automatically. Your members will have continuous access to ID cards, alerts and electronic notices.

Mobile Digital Platform is a modular solution built using the REACT native platform and service-oriented architecture, making it highly configurable for your enterprise. Settings such as session timeout, maximum invalid login attempts, errors, labels, headings and more are all configurable. The Platform is flexible enough to accommodate your specific branding and packaging needs.

Ensures compliance with federal requirements to improve patients’ access to their medical data

The Gainwell Patient Access and Interoperability Service provides your organization with a full range of services to support the rule’s requirements, including: transforming data; developing Fast Healthcare Interoperability Resources (FHIR)-based API services for patient access to claims, formulary, clinical and encounter information; implementing provider directories; and publishing APIs.

Our service addresses the 21st Century Cures Act CMS Patient Access and Interoperability Final Rule, which outlines the path to overcoming a long-standing issue in the U.S. healthcare system: transparent and holistic patient/member access to information.

The final rule puts patients first, giving them more control over their healthcare decisions by driving greater interoperability and data exchange across the entire healthcare ecosystem. While the HITECH Act sought to expand the use of EHR systems in the provider space and introduced patient portal capabilities, the limited push toward interoperability meant that most of these systems became silos of patient data. Most patients must use multiple portals based on the providers they see with no consistency across the platforms.

The common thread across all these systems is often the payer. That is, each of the various points of care send claims to a payer to which the member is assigned. By requiring the payer to provide a single access point for the individual that includes claims and clinical data, the patient is afforded a single, consistent and cohesive view of their healthcare information.

As a cloud-based platform, our service is designed to grow with the additional use cases that will undoubtedly come as CMS continues to expand interoperability.

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