TeraMatch® at Work for a Medicaid Contractor
Situation:
Company A is a Medicaid contractor that administers the Medicaid program for a large state. They
have a complex provider database with extensive data that has been maintained in two different transactional systems
over the past 30 years. As part of their enrollment process, Company A must inspect several exclusion lists and the
provider database before enrolling a new provider. This is a complicated and time-consuming process, due to the
number of different exclusion lists and disparate list locations and types. Some of the exclusion lists are located
online and others are in
spreadsheets, which further complicates their situation.
Protocols:
In the past, it took Company A up to an hour to inspect the exclusion lists and to enroll a new
provider. In addition, they would often miss critical information due to data quality issues within their files.
Enrollment processors searched each list manually using the name, common name variants, tax id, and address parts
to find providers on the list. The owners and any associated providers were also searched in this manner. Identifying
providers was made more challenging by the inconsistent data entry methods and poor data quality methods on each
exclusion list.
Challenge:
It became apparent to Company A that their methods of processing provider applications and
verifying provider eligibility were time-consuming, and that the process introduced opportunities for error. In
addition to lost productivity, Company A also realized that they were at risk of being penalized for improperly
enrolling providers and paying claims to providers on exclusion lists. They need to find a more efficient and
error-proof enrollment process to improve productivity and reduce the risk of penalizations.
Solution:
S3 Matching Technologies’ TeraMatch® solution addressed both provider duplication and provider
exclusion. Through an interactive match, Company A was able to streamline the verification that an enrolling
provider had not been previously enrolled. In addition, they were able to improve the identification of providers with
duplicate identification numbers through reports and workflows. S3 addressed identifying excluded providers by
providing a single interactive,
point-of-service match that matches the provider data to all of the
exclusions lists at the
same time in the same place. Company A was also able to improve the identification of established providers who
were later sanctioned through the use of reports and workflows.
Benefits:
By using the S3 solution, Company A saved 7 Full-Time Equivalent’s per year work in provider
enrollment, reduced duplicate enrollments and, most importantly, more accurately identified excluded providers.
In addition, Company A saved in excess of several million dollars per year through increased productivity and
risk avoidance.
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