Wednesday, April 19, 2017

Credentialing Made Easier for Medicaid Providers in Texas

This article was originally posted on Texas Dentists for Medicaid Reform

New Legislation

In Texas, private health plans or managed care organizations (MCOs) manage the Medicaid program for the State. The State began transitioning to this approach, called the managed care model, in recent years as an alternative to the former costly and inefficient fee-for-service (FFS) model. The managed care private-market approach drives innovation through flexibility and competition, reduces health care costs, and holds Medicaid health plans accountable for providing access to quality care. It has saved the State and Texas taxpayers $4 billion over a six-year period and is expected to save another $3 billion or more by 2018.

Through this process, MCOs gather and assess background information on health care providers in an effort to confirm the provider is in good standing, ensure patient safety, and prevent fraud, waste and abuse. As it stands, each MCO gathers this background information from providers separately and with varying deadlines, requiring providers to submit and re-submit their information to all 20 Medicaid health plans individually and at different times.

Recently, Texas Medicaid health plans brainstormed on how to simplify this process for physicians and providers and make Medicaid a more welcoming program for quality providers to participate in and provide care to Texas patients. The health plans proposed a statewide CVO concept, which was endorsed during the 84th Texas Legislature in SB 200. The bill establishes a way for Texas to streamline the Medicaid provider credentialing process.

How Does The New Process Work?  

First, there will be a single source for all credentialing information. That means that if a physician or provider in an area of the state wishes to participate in the network of several health plans in that area then the provider information need only be collected once and is then shared with all of the plans.

Second, the Texas Medicaid health plans elected to adopt a single re-credentialing date. That means that when a physician must be re-credentialed, generally a process that occurs every three years, the doctor will be re-credentialed once for all of the participating plans.

The project implementation will begin immediately with  statewide operations expected to begin October 2017.

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