Thursday, June 14, 2012

Why Did NC Medicaid/ DMA Not Require LME's to Utilize Already in Place CAQH Provider Credentialing Process?: WHY?

This is an idiot's way to manage the providers coming into the LME's.  The cart is so far ahead of the horse that it has run off the side of the mountain.

When I read this on a DMA webpage, I was stunned. NC DMA TALKS about how it 'INTENDS' to utilize the CAQH credentialing process 'IN THE FUTURE.'


LIP (Licensed Independent Practitioner) Credentialing

As noted in the last March Special Medicaid Bulletin, LME-MCOs have been working with
stakeholder groups on streamlining the enrollment process.  As of this date, the following LMEMCOs will be using the Council for Affordable Quality Healthcare (CAQH) to gather
credentialing data for Licensed Independent Professionals (LIP):

• CenterPoint Human Services
• CoastalCare (Southeastern Center and Onslow Carteret)
• The Durham Center/Cumberland/Johnston/Wake
• Partners for Behavioral Health Management (Pathways, Crossroads and Mental Health
• Sandhills
• Smoky Mountain Center
• Western Highlands Network

DMA will publish updated CAQH information as other LME-MCO make decisions about
working with enrollment and credentialing vendors.

!!!!!!!!!!The contracts between CAQH and the LME/MCOs listed above are being currently developed.!!!!!!!!

   Future Medicaid Bulletins will notify providers when they can begin using the CAQH on-line enrollment process.  
CAQH provides a streamlined, secure method for electronic data collection – at no cost to the
provider.  Providers keep total control of the data, authorizing access only to the participating
LME-MCOs of their choice.  Revisions made by the provider are available instantly to
authorized LME-MCOs.  Additi

CAQH is a national provider credentialing process that providers update every 3 months.  As associated with that process, the CAQH people had to have received your license information, etc.

Why is CAQH important?

Because it could have COMPLETELY removed all of this credentialing boondoggle as providers have already signed onto this CAQH credentialing.  Any insurance company can obtain access to that information.  And that would include the LME's.

WHY didn't DMA require the LME's to utilize the CAQH credentialing?

Why are these people so completely flummoxed and incapable of running efficient organizations?

Why are all the Medicaid dollars being consumed through useless, time-consuming, inefficient processes like this provider credentialing process when CAQH has been in place for years?



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