State Medicaid Agencies

Open Doors

Serve your community and improve access to quality care by streamlining and automating medical provider credentialing services

MEDICAID PROVIDER DATA MANAGEMENT: THE PATH TO BETTER HEALTHCARE ACCESS

Verisys aligns medical provider credentialing and directory services for state Medicaid agencies, reducing cost and administrative burden, while increasing provider and member satisfaction. Our credentialing solutions streamline and consolidate siloed departments to deliver tangible results:

  • 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 CMS ACA3 medical provider screening and management requirements.
  • Integrate to a State Enterprise Architecture.
  • Comply with Medicaid Information Technology Architecture (MITA) 3.0 standards.
  • Automate credentialing and onboarding 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.

The bottom line for state Medicaid agencies: better healthcare access.

Credentials Verification Organization

Fee-based state Medicaid agencies can get medical provider credentialing with primary source verifications by the only CVO with statewide alliance management. Verisys CVO services also include automated verifications, sanctions monitoring, flexibility, and scalability. Our credentialing solutions are built for the high volumes that state Medicaid programs manage and we are positioned to scale with you as you grow.

Credentialing Alliances

We operate multiple statewide credentialing alliance programs, where credentialing is performed once and verified credentials are shared with all plans. We have managed credentialing alliances for more than 10 years and know how to help state Medicaid agencies and consortiums get effective alliance programs up and running.

Enhanced Services

Verisys offers provider monitoring for exclusions and license status, re-credentialing roster management, and committee review administration. Add these services to enhance your core primary source verification Medicaid provider credentialing services.

Provider Directory and Data Quality

We enable regulatory compliance with technology that adheres to provider directory accessibility standards, price transparency requirements, and Centers for Medicare and Medicaid (CMS)-mandated FHIR APIs. Medicaid members can quickly find the right providers for their needs knowing the provider data will always be accurate and up to date.
As a government entity, you’re held to high standards. Verisys helps you meet them as a Credentials Verification Organization 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).
VERISYS IS THE TOP CREDENTIALING ALLIANCE PARTNER FOR STATE MEDICAID AGENCIES
CheckMedic is a SaaS platform that streamlines end-to-end provider credentialing, monitoring, and data management.
VerisysConnect offers an efficient and highly accurate means to perform data inquires and primary source verification for provider credentialing and compliance through its self-serve engine.
Enrollment accelerates and simplifies the application, verification, and attestation process for network providers.
Data Services improves data accuracy, timeliness, and quality by eliminating inaccurate and incomplete provider data.
Provider Directory meets compliance and consumer demands for easy-to-use online, mobile, and printed formats.
Verified License Search and Status, VLSS, assures that the licenses, registrations, and certifications held by a provider are current, in good standing, and in line with credentialing, privileging, and enrollment requirements.
ProviderCheck gives an instant pass/fail status on the five critical data points of a prescriber’s status. Dispense and file claims with certainty.
Network Management strengthens your provider relationship management with a custom Salesforce app.