The Importance of Keeping Your Medicaid Records Up-to-Date: What Providers Need to Know in 2024
It’s crucial to continually review and update your Medicaid records to ensure they accurately reflect your current practice details. This includes verifying facility names, addresses, and the providers associated with each location.
All of this information must align because insurance companies often refer to your Medicaid enrollment status. The 21st Century Cures Act, enacted in 2016, requires this, and enforcement is picking up this year, especially here in Minnesota.
In our home state of Minnesota, MCOs are now requiring provider approval letters with matching practice information before approving contract applications and contract changes. One MCO is currently indicating the will stop paying on claims if individual providers are not showing as enrolled, or if location and business information on file with Minnesota Health Care Programs (MHCP) does not match.
DHS is The New Gold Standard for Provider and Practice Demographics
As a result of these new rules, in Minnesota at least, consider what’s on file with your state Medicaid program the gold standard for your group and individual provider information. For providers in other states we recommend you do the same. First and foremost, you must keep MHCP updated and accurate before all other contracts.
Even if you’re already enrolled with your state’s Medicaid program: Did you get enrolled correctly? Has your business or service address(es) changed? Have you added clinicians and neglected to update the state? Did you send in the update paperwork, but was it lost by your state’s Medicaid program?
Call or log into your provider portal. It’s worth the time given what might happen if Medicaid is out of date or perceived by an MCO to be out of date.
More Detail and the Overall Ramifications
One large Minnesota-based MCO is indicating they’ll stop paying claims if Medicaid records and what’s on file at the MCO do not match. These were the general criteria they used:
Individual Providers who do not appear to be enrolled in at least one service location. The address on file at the MCO does not need to match MHCP.
Group Providers whose service location addresses, including Name, Address, TIN and NPI, on file at the MCO do not match the records on file with MHCP.
If you don't update your information or get enrolled:
The MCO will be the first to potentially stop paying
Other MCOs will likely follow suit
You can't apply for new contracts with MCOs until you’re up-to-date
You can't modify your existing contracts MCOs until you’re up-to-date
Contracts are King
That means what’s on file with all your payers matters. Keeping your practice and individual provider information up to date is confusing, complex, frustrating, but it’s absolutely necessary. Every payer has a different process and different requirements, forms and ways to go about it. The learning curve is steep and time consuming, but for anyone having issues with growth or claim payments, as billers we know: It often goes back to the contract.
If You Want Help with This Process
BreezyBilling does not do contracting or credentialing work. We focus on billing. However, we have been helping many providers work through their Medicaid enrollment information as well as their MCO and commercial payer information through our sister company, Phoenix Credentialing.
