First-year implantation phase to begin in July for fee-for-service provider screenings. 

The Mississippi Division of Medicaid plans to implement a centralized credentialing process for managed care providers enrolling in MississippiCAN or Children’s Health Insurance Program (CHIP) coordinated care organizations (CCOs).

This is part of an on-going effort to cut down on red tape and reduce administrative overhead for health care providers.

Drew Snyder, Director of the Division of Medicaid

“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.”

The implementation will take place over 12 months beginning in July of 2022. Providers will follow the DOM’s current screening process to qualify for Medicaid fee-for-service and MississippiCAN. This will allow for immediate admin relief and will not jeopardize health plan accreditation if approved by the National Committee for Quality Assurance (NCQA).

There are three CCOs administering MississippiCAN: Magnolia Health, UnitedHealthcare Community Plan, and Molina Healthcare. 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 is lengthy and often requires the submission of additional documentation and related paperwork. Also, providers must currently credential with multiple entities as described above.

Through bills from the Legislature the DOM is able to simplify the operation by enabling providers to credential through one single avenue that will not only qualify them, but 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.