Provider Management Services

Count on a proven, federally certified provider solution

Our Provider Services solution achieved the modular certification requirements and processes by the Centers for Medicare & Medicaid Services (CMS). 

Modernized provider management functionality

As service delivery needs evolve to support healthcare initiatives, our Provider solution offers cost-effective web-based self-service capabilities to help states address the enhanced requirements — particularly in the screening, enrollment and ongoing management of provider relationships. 

Our provider management solution:

  • Ensures only qualified providers who are free of financial misconduct are allowed to serve state beneficiaries
  • Provides a simplified approach to establishing and maintaining an efficient relationship with a qualified provider network
  • Establishes an effective process of provider risk segmentation, assessment and site visit confirmation that ensures integrity
  • Enables provider access to online screening and enrollment functions backed by responsive customer service
  • Allows accurate and timely exchange of data between existing state systems and the Provider Data Management System (PDMS)

Provider credentialing support

In addition to screening and enrollment, our PDMS supports credentialing of medical providers to URAC and National Committee for Quality Assurance (NCQA) standards. These capabilities can be implemented with minimal impact to your current operations as they require no modifications to your existing Medicaid Management Information System (MMIS) and can be hosted and fully staffed by Maximus.

MITA and CMS standards

Our Provider Services solution satisfies all elements of the Medicaid Information Technology Architecture, Service Oriented Architecture and the Centers for Medicare and Medicaid Services Seven Conditions for Enhanced Funding standards.