Managed Medicaid: The nightmare within

Written by Allyson Schiff, Vice President of Operations, Newport Credentialing Solutions

In honor of Halloween, Newport Credentialing Solutions’ Vice President of Operations, Allyson Schiff, spotlights a nightmarish Medicaid situation which providers throughout the country are being forced to live.

Earlier this year a mandate was introduced requiring providers to complete state-specific regulated Medicaid enrollment before they can enroll in Managed Medicaid plans. Failure to enroll in state regulated Medicaid plans means a provider is unable to proceed with Managed Medicaid plan enrollment. While the mandate seems simple, there is hidden horror in this situation. It can take months for a provider to get enrolled in a state Medicaid plan; and many times they can’t begin the application process for Managed Medicaid enrollment until after state Medicaid enrollment is complete. This translates to months of delays before a provider can see patients and get paid. And the nightmare doesn’t stop here. For providers who work across state lines the horror is multiplied as they must be enrolled in each state’s Medicaid plan before they can move forward with their respective Managed Medicaid applications.

Established providers that have been grandfathered into Managed Medicaid plans for years but have chosen not to participate in state Medicaid are also faced with a gruesome reality. Either they enroll in state Medicaid or risk of being pushed out of their existing Managed Medicaid plans which may, in turn, result in loss of established patients.

While all sounds doom and gloom, there are some things that can be done to minimize the pain of this wicked situation.

1) Get enrollment started with state-specific Medicaid enrollment as quickly as possible to avoid needless processing delays. When onboarding, immediately after a provider signs a contract with a hospital, large health system, or physician group start the Medicaid process.

2) Talk with your contacts at Managed Medicaid to learn about your options as quickly as possible. Ask for leeway. Some plans may be willing to work with you if they know the enrollment process for state Medicaid is underway.

3) Put a reliable process in place to manage provider enrollment. Cloud-based enrollment software that streamlines Medicaid follow-up can literally become a lifesaver. Automated alerts let staff know the minute a state Medicaid enrollment is complete so they can immediately begin the Managed Medicaid application. Otherwise staff are left to wait for Medicaid approval to come through snail mail or they must be very diligent with repeated calls for approval status. This manual process can easily add two months to the approval process.

There is no escaping the new Managed Medicaid mandate. For those who don’t take it seriously, the nightmare will become reality. Patients, some of whom may have been in existence for decades, may find their participating providers have been dropped out of network. When patient volume is lost, so too is revenue, which leads to consequences too horrifying to consider. Being prepared, with cloud-based enrollment software will end the nightmare before it begins.

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