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Medicaid to implement centralized credentialing process for Medicaid managed care providers in July

Fee-for-service provider screening process to satisfy provider credentialing obligations
during first-year implementation phase

Jackson, Miss. – As part of an on-going effort to cut down on red tape and reduce administrative burdens for health care providers, the Mississippi Division of Medicaid (DOM) will be implementing a centralized credentialing process for providers enrolling with any MississippiCAN or Children’s Health Insurance Program (CHIP) coordinated care organizations (CCOs).

During the initial twelve-month implementation period beginning July 1, 2022, providers will simply need to follow DOM’s current screening process to qualify for Medicaid fee-for-service and MississippiCAN. This approach will offer immediate administrative relief and, if approved by the National Committee for Quality Assurance (NCQA), will not jeopardize health plan accreditation.

Currently, MississippiCAN is administered by three CCOs – Magnolia Health, UnitedHealthcare Community Plan, and Molina Healthcare – while CHIP is administered by Molina Healthcare and UnitedHealthcare Community Plan. Providers who wish to enroll in those networks are required to complete a separate credentialing process with each plan to verify that they are qualified providers. Additionally, they must undergo re-credentialing every three years to ensure their information is still accurate and up to date.

The traditional “credentialing” process, which is required of all health plans by NCQA, can be arduous and lengthy as completion often requires the submission of additional documentation and related paperwork. Also, providers must currently credential with multiple entities as described above. However, with support from the state Legislature, DOM is working to simplify the operation by enabling providers to credential through a single avenue that will qualify them, and then allow them to contract with any CCO. DOM screens providers enrolling in fee-for-service Medicaid but has not been required to credential.

When the implementation period ends on June 30, 2023, providers will have a centralized hub for credentialing in Medicaid-related benefit programs.

“The Division has made it a priority to better understand the challenges voiced by providers and sought to work together toward meaningful change in support of our shared goal of better outcomes for beneficiaries,” said Drew Snyder, executive director. “Streamlining provider credentialing will be a huge step toward focusing on patients instead of processes, and we are grateful to the Legislature and provider community for their partnership on this initiative.”

DOM will share more information about the credentialing process as those details develop.

Published April 18, 2022