2018 State HIT Connect Summit

The Affordable Care Act (ACA) substantially changed the requirements for screening and enrollment of Medicaid providers. Providers must be placed into categories of risk; Limited, Moderate, and High. There are new requirements for periodic background and sanction checks, facility site visits, fees, and many other tasks. Another complicating factor is the role of Medicaid Managed Care Organizations (MCOs) in this process. While MCOs typically have responsibility for provider credentialing, it is often separate from screening & enrollment, creating redundancy and confusion for stakeholders. A number of States have begun to combine the Credentialing process with Medicaid Screening & Enrollment. This roundtable will explore what states are doing and the implications for Medicaid Programs, MCOs, and Providers.