CMS Modern Claim Adjudication Development Services
Changing a policy shouldn’t mean rebuilding a system
Medicare processes more than one billion original claims every year. The technology behind those claims has to interpret complex policy, exchange information across multiple systems, and keep payments moving accurately and reliably. But decades-old claims processing systems made change difficult. New policies could require costly modifications across tightly connected legacy technology, with change cycles measured in years rather than sprints. Modernizing those systems meant changing how Medicare processes claims without disrupting the systems already doing it. Through Modern Claim Adjudication Development Services, or MCADS, CMS set out to build a more adaptable foundation for claims processing, one that could support immediate needs while creating a path toward broader Medicare modernization.
What We Built
Start small, build for what comes next
We helped CMS build the Medicare Adjudication Platform (MAP), its first cloud-based claims processing system. Rather than attempting to replace Medicare’s entire claims ecosystem at once, the team began with dental claims, building the capabilities needed to ingest, validate, adjudicate, and process them while integrating with the existing systems around them. In July 2024, MAP began accepting production dental claims, successfully processing Medicare claims in the cloud and establishing a foundation CMS could extend to additional claim types.
Design for change from the beginning
Modernizing legacy technology only works if the new system doesn’t inherit the same limitations. We used Domain-Driven Design and an Option-Enabling Architecture to separate Medicare policy and business logic from underlying infrastructure and organize the platform around components that can evolve independently. Instead of designing for one fixed end state, MAP was built to accommodate changing policies, technologies, and priorities without repeatedly rebuilding its foundation.
Deliver working capabilities, not disconnected pieces
We organized development around small, end-to-end vertical slices that move functionality through the claims journey from ingestion toward payment. Each slice creates a working capability that can be tested, validated, and improved before the team moves further, giving CMS opportunities to respond to what it learns throughout development. A shared backlog and cross-functional teams keep engineering, UX, DevSecOps, data, product, and delivery working toward the same outcomes instead of creating new organizational and technical silos.
Make quality part of delivery
For a system responsible for Medicare payments, moving faster cannot come at the expense of accuracy, security, or reliability. Automated testing, Test-Driven Development, CI/CD, Infrastructure as Code, security reviews, feature flags, monitoring, and observability are built into the development process. These practices allow teams to release and validate changes more frequently while catching issues earlier and maintaining the controls expected of a mission-critical federal system.
Build a foundation that can scale
Dental claims were the starting point, not the end goal. MAP gives CMS a working model for gradually moving claims processing away from costly legacy technology while making future policy and system changes easier to implement. The platform is designed to support broader claim types, improve data sharing, reduce reliance on redundant data stores, and ultimately help move policy changes from years-long technology efforts toward sprint-based delivery.
What We Changed
Medicare claims entered the cloud
In July 2024, MAP began accepting production dental claims, successfully processing Medicare claims in the cloud. The launch demonstrated that CMS could move critical adjudication capabilities away from legacy infrastructure while continuing to support the accuracy, security, and reliability of Medicare claims processing demands.
Policy change can move faster
Legacy claims systems made responding to new policies complex, costly, and slow. MAP was designed to significantly shorten that cycle, giving CMS a path to move from changes that could take years to changes delivered in sprints. That means technology can respond more quickly as Medicare policies and program needs evolve.
Modernization doesn’t have to mean starting over
By separating policy logic from infrastructure and designing around change, MAP gives CMS a foundation it can continue extending rather than another system that will eventually need to be replaced wholesale. Starting with dental allowed CMS to prove the approach on real claims while avoiding additional investment that would have made its legacy environment even more complex.
One foundation can support what comes next
MAP was never designed to solve only dental claims. It established a model CMS can build on as modernization expands to additional claim types, with the potential to consolidate legacy systems, improve data sharing, reduce redundant data stores, and make the broader Medicare claims ecosystem more adaptable over time.