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Using Self-Service Innovation to Streamline Provider Experiences

(3 of 4)

(In this third installment of our four-part series on Provider Experiences, we examine empowering providers throughout the process.)  

Navigating the Medicaid enrollment process can often feel like deciphering a puzzle. Inconsistent enrollment application elements across the broad network of payers leads to confusion and prolonged processing times. Following submission, providers often struggle to track the status of their applications and understand the next steps in the enrollment journey. Here are some innovative ways to bring clarity to the process.

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Promote More Transparency

Providers need the ability to track their application status after submission. One of the primary reasons providers contact call centers is to inquire about the status of their enrollment application.

Extend Self-Service Capabilities

In today’s world, people are accustomed to self-service options, from grocery store checkouts to airport kiosks. Medicaid agencies can enhance their portals and user interfaces to offer a similar experience. Providers should easily update and manage their information, submit claims, check member eligibility, access the provider directory, request prior authorization, and more.

One approach to engaging with providers effectively is the use of an AI-powered conversational voicebots and chatbots to revolutionize self-service. At one Medicaid agency, in just nine months, this innovation reduced call volume to agents by 34%. Additionally, because of its effectiveness, callers  enjoy quicker access to the information they need, spending 30% less time interacting with the voicebot compared to the traditional Interactive Voice Response (IVR) system. This frees up provider and agent availability and allows agents to focus on more complex calls and escalations.

Leverage Existing Data When Available

Gainwell’s insights reveal that the average enrollment form has over 185 fields, with more than 70% of this information available elsewhere. By utilizing existing data from credible data registries and other sources, Medicaid agencies can eliminate the need for applicants to re-enter known information and can automate data exchanges with those sources to further reduce provider data update requirements.

Use AI to Predict and Eliminate Risk and Errors

AI is a powerful tool for psychographic profiling, quickly classifying providers based on their interactions with enrollment systems to predict their experiences. Providers’ psychographic risk scores are available to call centers to prevent adverse experiences. Medicaid agencies can use this approach to predict providers at risk of negative experiences based on portal touchpoints, surveys, call center interactions, emails, complex patients, and prior authorization denials. Once identified, they can target those providers for reconciliation efforts to repair their experiences and prevent them from exiting Medicaid or limiting new patient acceptance.

AI can also predict providers likely to face issues such as failed enrollments, revalidations, or return to providers (RTPs) due to missing data. With this insight, agencies can proactively develop training, call center and support protocols to close the underlying gaps that cause these issues. 

Apply Process Mining and Journey Mapping

By creating process models and provider journey maps of high-risk areas, Medicaid agencies can take a comprehensive, “outside-in” look at all elements of the provider experience to identify and address improvement opportunities. This kind of approach points to functionality and process changes that will resolve pain points and improve provider experience outcomes. Strong data analytics enable agencies and vendors monitor improvement over time and ensure that these intervention tactics are working.

Look for our final installment in this series coming soon. Meanwhile, visit gainwelltechnologies.com to catch up on the previous articles. For those interested in exploring these strategies for friction-free provider experiences further, our white paper offers an in-depth guide. Dive into the details and discover how to transform provider experiences effectively, or contact us for more information.

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