Medicaid Contract Compliance Management

State Medicaid divisions are still faced with the daunting task of managing contract compliance with participating Managed Care Organizations (MCO) often using paper and other dated approaches. Such dated approaches are inefficient, not secure, and are vulnerable to errors on many levels.

Trinisys Convergence features a workflow architecture that enables states to modernize contract compliance management by implementing workflows that allow for the secure processing of all tasks related to contract compliance. Tasks such as the submission of contract deliverables, business owner reviews, and sanction assessments can be role-based and can conform to any business process workflow. Additionally, special exceptions that need to occur within those workflows can be included.

Streamlined workflow and automation capabilities eliminate the cumbersome, manual tasks MCOs face when processing contracts

The scalable, user-friendly application data model is fully capable of adapting to additional capacity needs and assisting in the onboarding of MCOs

Advanced security features from the Convergence platform, paired with the integration of the organization’s current security scheme, ensures that data is protected, and all activity is recorded.

The application can be hosted as an on-premise solution or can be cloud-hosted without rewriting the application

Problems Solved and Advantages of the TOPS Implementation

  • Manual and time-intensive tasks were eliminated with configurable automated finance processing.
  • Compliance turnaround time was improved by implementing automated contract deliverable queues.
  • Full support for data in the legacy system allowed users to easily access historical data and experience a seamless transition to the new system without having to support legacy code.
  • Multi-step processes once supported by spreadsheets were replaced with a web interface that allowed for more direct and accurate management of contract data.
  • Flexible notification subscriptions have allowed users to be better informed about a variety of events that can occur in the application.
  • The former custom security implementation was replaced with one that allowed full integration with the existing Active Directory system. This also provides better security for users who are external to the organization.


  • Custom workflow definitions can be implemented without compromising the needs of core business, allowing for seamless organization of process-related compliance tasks
  • Application administrative functionalities and role-based security integrates with the workflows to protect data across organizational roles
  • Full audit capabilities and workflow history records user activity to greater provide transparency to regulators for audit purposes
  • Event-driven automation enforces workflow rules, generates reports, performs accounting functions, alerts users, schedules the delivery of compliance information, and more
  • Aggregation and batch processing of financial data removes the manual tasks associated with preparation work and allows users to access essential information and export it quickly
  • A wide variety of authentication methods are supported to allow users inside or outside of the organization to securely authenticate into the application
  • Data from legacy systems is supported through a variety of ways including API connection, search capabilities in the Convergence platform, and a repository for archived legacy data

Convergence Integrations

Build vs Buy

When looking to make software investments, companies are often faced with the decision of Buy VS. Build. But what if there is a happy medium, the best of the buy AND the build... that'€™s Trinisys Convergence.

  • Buy

    • Pay for functionality you don't need
    • Rigid feature list, lack of customization
    • Expensive per ticket support models, offshored call centers
    • Additional charge for each system connected
    • Have to go back to the vendor for each change
    • Narrow feature focus and limited versatility
    • Expensive conversions and replacements required to put into place
  • Trinisys

    • Rapid time to market
    • Custom fit solution
    • Knowledge Base and Live support
    • Unlimited connectivity
    • Make changes without vendor involvement
    • Maximize reuse and extensible via Trinisys API
    • Leverage existing investments and extend systems already in place
  • Build

    • Requires development team
    • Slow time to market
    • Must be supported internally
    • Obligation to maintain in house
    • Competes with other in-house development projects
    • Start from scratch with every project
    • Integration can be challenging

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