Medicaid programs have become more complex while also gaining  enormous visibility in recent years. Due to constant changes in provider credentialing and enrollment policies, states around the country are having to piece together systems or hard-code changes within their Medicaid Management Information System (MMIS) to ensure compliancy with rapidly changing regulations and policies. Our Provider Management solution addresses this by providing:

• A stakeholder-centric view unconstrained by system or organizational barriers.
• User- and provider-friendly services and solutions.
• Available data that is timely, accurate, usable, and easily accessible to support the analysis and decision-making processes of healthcare management program administration.
• A reduction in redundant processes that frustrate providers.
• A technical environment that supports flexibility, adaptability, and rapid response to changes in programs.

The Wipro EMaaS - Provider Management Solution is powered by Medversant’s Electronic Credentials Verification and Management system to deliver a seamless, efficient, and robust provider enrollment and credentialing management experience. Our solution provides credentials verification services in accordance with the National Committee for Quality Assurance (NCQA), the Utilization Review Accreditation Commission (URAC), the Joint Commission, and other regulatory requirements at the time of initial credentialing and subsequent re-credentialing for all physicians. Our comprehensive solution suite includes the following:

• The Enrollment and Credentialing Portal directly links health networks and providers through an online, comprehensive provider application. Compliant with the credentialing standards of NCQA, URAC, HIPAA, and the Joint Commission, this web portal features electronic signature capabilities and allows health plans to automate credentialing and enrollment processes through one innovative platform.
• Group Manager enables a single user to manage the credentialing documents for an entire office or group practice, and a trusted relationship can be established between practitioners and their administrators. Those administrators can then centrally manage location information that automatically updates individual practitioner records affiliated with that location.
• The Client Portal acts as the primary administrative tool for Medicaid agencies, allowing clients to access a completely transparent view of every data process. From application submission to completion, from primary source verification to ongoing monitoring, the user-friendly Client Portal allows concentrated access to provider data, verification status, and customized data analysis reporting at any time. It also serves as a repository for credentialing data, documentation, and primary source verifications.
• Application Tracker is a monitoring system that tracks the progress of a provider’s credentialing application. It monitors collection and completion requirements, documents outreach results, updates provider information, and uploads documents received from providers.
• AutoVerifi™ is Medversant’s patented process technology that can truly automate data verification through electronically available credentialing sources. It features an automated and customized verification service specific to each provider that searches primary source databanks, captures images and data specific to the primary information source, and automatically updates the centralized licensee record. With the support of this advanced technology, over 7.2 million healthcare providers nationwide have been credentialed, screened, monitored, and/or enrolled on behalf of over hundreds of health plans, health systems, and government agencies.
• The Virtual Review Committee (VRC) is a web-based tool that manages the post-screening acceptance, rejection, and termination of provider applications. As a customizable rules engine, it’s capable of automatically gauging and scoring provider issue levels-based screening results, allowing for synchronous or asynchronous file reviews by one or more staff members.