Provider Surveillance

Quickly Spot Risk

Preventing risky providers from entering your network and quickly detecting those high-risk providers already in your network are both critical to maintaining the integrity of your program. As a result of the Patient Protection and Affordable Care Act (ACA) of 2010, the Center for Medicare & Medicaid Services (CMS) has established new requirements for provider screening and enrollment. Each state is responsible for implementing the new screening and enrollment requirements for those providers enrolling only in Medicaid or CHIP. Medicaid providers not enrolled in Medicare must be evaluated and assigned an appropriate categorical risk based on their provider type. Further, every state Medicaid agency must acquire and maintain birth dates and Social Security numbers for all persons with an ownership or controlling interest in a Medicaid provider.

Provider Surveillance chart
Benefits
  • Meets the new CMS enrollment and monitoring standards without the need for additional staff
  • Passes CMS audits for payment integrity
  • Aligns state provider enrollment processes with ACA 6028 standards
  • Uses a single credentialing solution to enroll all providers
  • Transforms your manual processes into a paperless system with automated monthly monitoring
  • Eliminates the need for additional software and hardware purchases, as well as training and maintenance
  • Enables easy sharing of your approved network with Medicaid managed care organizations