The hardest part of credentialing and enrollment is staying on top of the ever-changing processes. Our expert team keeps up with changes by attending conferences, live talks, and Medicaid webinars, and getting newsletters from relevant associations and insurers.
Download the NCTracks Medicaid “Journey to Modernization” presentation
here.
As busy healthcare leaders, you simply don’t have time to sift through packets of information or catch a Medicaid webinar during lunch.
We want the absolute best for you, so we’ve asked Teresa Faulconer, Credentialing and Enrollment Lead Representative to take what she learned during the NCTracks Medicaid Presentation in June 2023 and give us a bite-sized breakdown of the important changes with actionable insights.
Straight from Teresa’s own notes on the North Carolina Medicaid changes:
In 2017, Session Law 2017-57 authorized the replacement of current Medicaid Management Information System (MMIS) technologies with modular systems.
2 major benefits of the system change
1. NC Medicaid Managed Care Transformation Roadmap will
a. Ease the provider's administrative burden.
b. Modernize PDM/CVO technologies.
c. Simplify and enable responsive access for Medicaid providers to participate in NC’s Medicaid Program.
2. PDM/CVO will be operational in 2024 and will
a. Align with NC Medicaid Managed Care Transformation Roadmap.
b. Streamline data intake and maintenance throughout the provider lifecycle.
c. Perform provider enrollment and credentialing on behalf of NCDHHS.
d. Detect and prevent fraud, waste, and abuse.
e. Eliminate redundant entry of information.
f. One set of standards.
g. Online portal.
What does this mean for provider data management?
Provider Data Management Credentialing Verification Product Features will include
a. Provider Self-Service Portal
b. Internal Portal
c. Call Center
d. Administrative Functionality
e. Credentialing Verifications
f. Credentialing Committee
How will NCDHHS acquire, test, and implement the new PDM CVO module?
Stage 1 “Acquire”
Stage 2 “Configure & Test”
Stage 3 “Implement”
Read the complete NCTracks Medicaid “Journey to Modernization” presentation here.
To help you and your staff navigate these changes, the NCDHHS will engage in provider-focused education and outreach to help providers transition from the current Medicaid provider enrollment process to the transition period processes and then to the entire centralized credentialing process under full implementation.
Communications will include
provider association webinars,
ongoing stakeholder meetings,
training, and
outreach to enrolled providers, prospective providers, associations, and stakeholders. Please visit the
NCTracks Medicaid website for updates, and
contact us with any questions.
Phone: (317) 237-5770
Fax: (317) 237-5777
Address: 9425 Delegates Row Indianapolis, IN 46240
Phone: (317) 237-5770
Fax: (317) 237-5777
Address: 9425 Delegates Row, Indianapolis, IN 46240