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So, what share of $30 Billion your State drains annually?

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Did you know? In 2015, Medicaid accounted for ~$30 Billion in improper payments. With broadened eligibility criteria, Medicaid costs are ballooning for the States and so are its improper payments. Medicaid is marred by constant reporting of fraud and abuse with at least 1% of the enrolled providers found to be ineligible.

So, how much of those $30 Billion your State drains annually?

While about 100, 000 healthcare providers struggle every year to enroll themselves with various State Medicaid agencies, State Enrollment analysts are having a nightmare screening these providers and complying with new regulations.

Providers often employ consultants to fill out the enrolment application forms due to the inherent complexities involved. Employing consultants doesn’t reduce their enrolment timeline. Providers make between 3 to 5 calls to the call-center per application submitted. All these leads to high volume of calls for preparation support and status inquiries. IT is estimated that more than 20% of the applications are abandoned before submission and another 10% post-submission due to the frustration associated with complexities and delays.

For the State Enrollment analysts, the new compliance is mandating the States to focus on “Prevention” by enabling comprehensive screening and continuous monitoring. And the current enterprise systems lack important capabilities to record observations contextually, collaborate with internal and external stakeholders digitally and leverage system enabled intelligence to augment human decision making. As a result, , processing times are long and decisions are based on limited external verifications.

It takes anywhere between 8 to 12 months for the providers to get enrolled. Till then, they wait… at times without even knowing their application status. Now hold on! Not that the enrollment analysts are spared. In fact, their workloads just got already tripled with new regulations.

When was the last time you saw a healthcare provider or an enrollment analyst vouching that Medicaid enrollment is hassle-free?  Never. Right?

How will it be to have a clever and collaborative application that

  1. Talks to providers in filling out forms
  2. Guides the enrollment analysts in understanding end-to-end provider background
  3. Learns from both providers and the enrollment analysts and adapts to their needs
  4. Complies with regulatory requirements
  5. Suggests the next best course of action on the form and the case
  6. Collaborates with you and all your relevant stakeholders

Introducing Know Your Provider industry’s first smart and modular provider network management system

KYP offers end-to-end provider network management while seamlessly complying with Medicaid regulations. With KYP, the entire process of provider credentialing becomes a paperless exercise and at least 80% of manual activities are automated. Not just that!

With capabilities like a. configurable virtual assistant, b. provider 360, c. intelligent risk scores, d. elastic security and e. never-before-social collaboration – “provider credentialing times” are reduced from months to minutes.

With KYP, Medicaid not only saves Provider and Enrollment analyst frustrations, it prevents draining of billions of $ in improper payments annually.  KYP has already resulted in a cost saving of more than $500 Million to our customers.

To know more about KYP, please write to strategic.marketing@dharbor.com

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