Enhancing Provider Experiences: Simplifying the Process

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(In this second installment of our four-part series on Provider Experiences, we focus on simplifying the revalidation process.)  

Revalidation is a necessary but often burdensome process for providers. The Centers for Medicare and Medicaid Services (CMS) and states mandate that providers revalidate their enrollment every three to five years. This requirement can be particularly taxing for large groups, facilities, and hospitals with numerous providers. The process can lead to the termination of non-responsive providers and challenges in meeting the required timeframe for revalidation.

Enrollment administrators, especially those overseeing large practices or hospital systems, face significant challenges due to the complexity and time required for updates. On average, completing a revalidation takes about 30 minutes per provider, with some specialties taking even longer. When multiplied by hundreds of providers, this becomes a substantial efficiency issue, often necessitating full-time resources dedicated to re-enrollments.

Strategies for Simplifying Revalidation

To address these challenges, state Medicaid agencies can implement several strategies to simplify the revalidation process:

1. Bulk Enrollment and Revalidation
   • Bulk enrollment and revalidation streamline provider re-enrollment by automating the processing of multiple updates at once, saving time and effort compared to handling individual updates. This is especially beneficial for managing large groups, such as providers within a practice or hospital system. By pulling in data from existing enrollment records, the process becomes more of a review than a new submission, allowing providers to quickly verify and update their information. This results in faster, more efficient re-enrollments with fewer errors
2. Leveraging Medicare Provider Information
   • The Medicare Provider, Enrollment, Chain, and Ownership System (PECOS) contains validated information about providers’ standing and CMS status. By accessing this system, state Medicaid agencies can reduce the administrative burden of duplicate data entry. For instance, Arkansas uses PECOS data to determine if Medicaid revalidation can be completed based on data matching, streamlining the process for both providers and the state.
3. Eliminating Unnecessary Requirements
   • State Medicaid agencies can review current revalidation activities to identify opportunities for streamlining. This may involve removing redundant provider agreement and attachment requirements and simplifying the application format. By working within CMS guidelines, agencies can make the revalidation process more efficient and less burdensome for providers.

Innovation in Practice

One state is enhancing provider experience by streamlining initial enrollment and revalidation within its Medicaid Enterprise System. Key to this transformation is the implementation of bulk initial enrollment and revalidation. In the near future, groups, hospitals, and facilities will be able to submit their entire provider network for system checks and reconciliation against National Provider Identifier and taxonomy combinations without needing separate applications.

Automation of the screening and review process will significantly reduce manual application reviews. Revalidation applications will be prepopulated with existing data, eliminating redundant data entry. Additionally, the state’s connection to PECOS allows some providers to bypass the revalidation requirement altogether. If PECOS has the NPI and a current validation, the revalidation date is updated to align with PECOS, negating the need for a second revalidation.

Since implementing these changes, half of the state’s providers no longer need revalidation. Future plans include incorporating more PECOS data, such as site visit information, fingerprinting, and background checks, to further reduce administrative burdens.

Moreover, the state’s medical assistance portal offers providers fast-track options, including the ability to complete disclosure statements at any time. These disclosures are systematically screened, reducing approval time to 15 minutes and eliminating the need for manual staff review.

Conclusion

Simplifying the revalidation process is a crucial step in reducing friction for providers. By implementing bulk enrollment, leveraging existing Medicare provider information, and eliminating unnecessary requirements, state Medicaid agencies can make revalidation more efficient and less burdensome. These innovations not only improve the provider experience but also enhance the overall efficiency of the Medicaid system.

Stay tuned for the next part in our series, where we will explore how to empower providers throughout the process. If you missed the first installment, you can find it here. For more information on a frictionless provider experience, read our white paper or contact us.