State Medicaid Agencies

Open Doors

Serve your community and improve access to quality care by streamlining and automating provider credentialing and enrollment.

SOLID STATE

Keep your state’s population solid and healthy with access to quality care. The easier it is to enroll and re-enroll competent providers, the more competent providers are available to serve your state’s population.

Streamlined provider data management with Verisys’ comprehensive data and SaaS solutions speeds and simplifies provider credentialing and enrollment while keeping your agency compliant.

Verisys offers a wide range of ways to serve state Medicaid agencies from self-serve access to FACIS, the gold standard of provider data and other important primary sources through its cloud portal VerisysConnect; to its comprehensive data-driven SaaS platform, CheckMedic that automates provider management end to end from exclusion screening, license verification, credentialing, enrollment, and continuous monitoring.

Streamline and consolidate siloed administrative duties with Verisys’ Provider Directory, Data Services, and Network Management suite of solutions. Provider Directory meets compliance and consumer demands for easy-to-use online, mobile, and printed formats. Data Services improves data accuracy, timeliness, and quality by eliminating inaccurate and incomplete provider data. Network Management strengthens your provider relationship management with a custom Salesforce app.

You are held to high standards. Verisys meets those high standards as a Credentials Verification Organization (CVO) with certifications and accreditations from the National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), International Organization for Standardization (ISO), and American Institute of Certified Public Accountants, Service Organization Trust Criteria (AICPA SOC2).

Solid benefits from streamlining provider data management:

  • Meet federal and state requirements in developing and maintaining a provider and entity population management system
  • Support the National Fraud Prevention Program (NFPP); 2 42 CFR Part 438, Subpart H; 42 CFR Part 455, Subparts B & E
  • Comply with Centers for Medicare and Medicaid (CMS) ACA3 provider screening, enrollment, and management requirements
  • Integrate to a State Enterprise Architecture
  • Comply with Medicaid Information Technology Architecture (MITA) 3.0 standards
  • Automate enrollment and re-enrollment of providers and entity populations with both fee-for-service and managed care entities
  • Automate provider and entity supplier screening
  • Proactively prevent and mitigate fraud, waste, and abuse through risk-based alerts

There’s a lot under the Verisys hood

High standards:

Verisys is the only Credentials Verification Organization (CVO) that is National Committee for Quality Assurance (NCQA) certified for 11 out of 11 verification services, is Utilization Review Accreditation Commission (URAC) accredited, and is ISO 9001:2015 (quality management), ISO 27001:2013 (information security), and AICPA SOC 2 (customer data security) certified.

Data platform:

Verisys’ comprehensive data platform contains more than 320 million aggregated records derived from thousands of primary sources — and growing. Data collection began in 1992 with its Fraud Abuse Control Information System (FACIS). Verisys stores cumulative records that provide a unique, longitudinal view of exclusions, debarments, sanctions, and disciplinary actions.

Data matching science:

Verisys developed a proprietary matching logic using algorithms in combination with oversight by data analysts to collect, transform, and match each piece of data to the right provider/entity consistently with 99.9% accuracy. We stand behind our results 100% of the time.

Technology:

Our innovative technology stack transforms millions of records into intuitive, interoperable formats. This powerful solution simplifies workflow for turnkey compliance and a better bottom line.

Software:

Verisys designed and built the first data-powered Software as a Service (SaaS) credentialing platform, CheckMedic 20 years ago. Solutions innovation continued with real-time search and transaction engines, VerisysConnect, and ProviderCheck that instantly deliver accurate provider data when you need it. These unique, comprehensive solutions streamline provider data management, credentialing, privileging, and enrollment.

From the Verisys Blog

What to Watch Out for When Conducting License Verifications and Credentialing

What to Watch Out for When Conducting License Verifications and Credentialing

When conducting provider license verifications and credentialing, it can be easy to miss signals that something may be amiss with a practitioner’s application. Sometimes red flags that should alert an organization to potential problems are obvious, but other times they are more subtle. In either case, it’s important for healthcare organizations to be vigilant and take appropriate action if these red flags appear. Otherwise, you could be risking the safety of your patients and the reputation of your organization. Once you know what to look for, it...

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Keys to Managing Risk with Free Clinic Healthcare Volunteers

Keys to Managing Risk with Free Clinic Healthcare Volunteers

Important Tips for Effective Background Screening, Credentials Verification, and Continuous Monitoring of Healthcare Volunteers to Avoid Harm to Patients and Legal Exposure In this blog, Hugh addresses the challenges that face free clinics when recruiting volunteers. Efforts to meet the demand of staffing numerous free medical clinics should not be done at the expense of proper background screening, verification of credentials, and license status. Lack of proper credentialing can pose major risks to the already vulnerable individuals these clinics...

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How to Implement New Medical Procedures

How to Implement New Medical Procedures

Adding new medical procedures or diagnosis technology requires analysis against a health system’s core purpose. In this blog, Hugh Greeley suggests that medical staff service professionals read, “The Deming Management Method,” by author Mary Walton. Greeley dedicates his focus on Point 1 of the 14 Points included in the book. Point 1 is, “Creating Constancy of Purpose.” Checklist of things to consider before making a change  Hugh lists nine questions that help align action with purpose. He points out that every new adoption of technology, procedure, or...

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The Changing Landscape of Telemedicine Billing, Payment, and Reimbursements (since COVID-19)

The Changing Landscape of Telemedicine Billing, Payment, and Reimbursements (since COVID-19)

Since the COVID-19 pandemic began, the use of telemedicine has greatly accelerated. Whether patients stay at home due to government mandates or due to concerns for their own safety, providers use telemedicine more than ever before as a way to provide care to patients without requiring an office visit. This has increased the availability and accessibility of care, but the increased use of telehealth services has made it more difficult for providers to receive payment for their services. What Are the Changes in Telemedicine Billing, Reimbursements, and...

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