10 steps to increase provider participation in Medicaid/streamline administration

Here are 10 steps to increase provider participation in Medicaid and to streamline the administrative process from Action for Dental Health, a nationwide, community-based movement aimed at ending the dental health crisis facing America today.

Action for Dental Health

  • Step 1: Talk with the manager of Provider Enrollment for your state and review the process for enrolling in the Medicaid program. Confirm basic information such as documentation expectations, electronic filing and ability to participate on a limited basis.
  • Step 2: Identify populations of interest that your practice will serve. Determine how those patients will access your practice, whether via local community outreach or referrals from the local community health center after being triaged.
  • Step 3: Discuss with your state dental association the current baseline of provider participation and the data that will be coordinated as reported by your state to the Centers for Medicare and Medicaid Services in its CMS 416 report. This information is the basis for determining what positive results are being seen due to increased provider participation.
  • Step 4: Participate in a state Dental Medicaid Advisory Committee or form a committee if one does not exist in your state. Invite other Medicaid providers, both private practice dentists and those working within community health centers, to participate.
  • Step 5: Review Medicaid rates, prior authorization and enrollment processes for your state. Are adult Medicaid benefits available? Was there an increase in providers if rates were increased? Learn what negotiation and compromise efforts were performed.
  • Step 6: To streamline your credentialing and provider eligibility process, review those states making a positive difference (Oklahoma, California, Maryland and Kentucky). Invite the people who perform the enrolling process to your Medicaid advisory committee to investigate what might be done in your state to expedite credentialing.
  • Step 7: Meet with the manager of your state Medicaid Integrity Program to learn of the processes they follow for chart audits and review. Explain the need for uniform compliance training for auditors for reviews. Discuss with your Medicaid Advisory Committee.
  • Step 8: Maintain strong lines of communication with the state Medicaid program, the state oral health program, the ADA and Medicaid-CHIP Dental Association who can be resources for you.
  • Step 9: Share program successes and failures with your local dental society.
  • Step 10: Write an article for your state dental association journal about your Dental Medicaid Advisory Committee, your experiences in treating the underserved and the value that dentistry can provide in communicating with the local medical community about the importance of integrating oral health for patient overall health.

To view the full 10-step process, click here. For more information about the ADA’s Action for Dental Health, visit ADA.org/action.

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