Provider Enrollment is comprised of three business units, the Managed Care, Facility, and Home and Community-based Services Unit, the Practitioner and Supplier Unit, and the Provider Eligibility and Compliance Unit.These units provide coordination of provider enrollment functions, provider data maintenance, outreach, education, and issue resolution to providers, the Medicaid managed care plans, the Medicaid Regional Offices, and program operating partners at the Department of Health and the Agency for Persons with Disabilities.
Responsible for coordination with Medicaid Plan Management for managed care provider and plan enrollment, Health Quality Assurance for facility enrollment and license actions, the Agency for Persons with Disabilities for Home and Community-based Services, and the Centers for Medicare and Medicaid Services for provider screening and eligibility activities.
Responsible for reviewing practitioner and supplier eligibility for all applicants with prior denials, sanctions or terminations from Medicare or Medicaid in this or any other state, a change of ownership, suspended payments from Medicare or Medicaid in this or any other state, rate setting requirements, or certification surveys.
Responsible for providing education, outreach, and enforcement of provider compliance with eligibility requirements, coordinating and reviewing provider background screening and on-site visits, and, validating Medicaid provider eligibility through analysis of federal exclusion databases and coordination of eligibility checks with other state Medicaid programs.
Responsible for researching and providing resolution for provider enrollment issues received from the Office of the Governor, the legislature, and agency leadership, and for coordinating and performing onsite reviews.