Problem Statement

Providers must be enrolled and credentialed with payers before their services can be billed, and a provider who isn't enrolled in time generates claims that deny or get written off. MassHealth periodically requires providers to revalidate their enrollment, and each provider's current standing has to be confirmed against the credentialing system before the revalidation file can be updated. Working the revalidation spreadsheet by hand is slow, and a missed revalidation can lapse a provider's enrollment.

Automation Solution

This automation retrieves provider enrollment details from MDStaff and updates the MassHealth revalidation file to mark each provider as active, requiring revalidation, or needing removal, then notifies providers of upcoming revalidations.