Provider Services

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DecisionPoint for Provider Services

Addressing Enhanced Requirements for
Provider Networks

The Affordable Care Act (ACA) mandated significant changes to states’ management of health provider networks — particularly the screening, enrollment and ongoing management of provider relationships. DecisionPoint® for Provider Services provides options to help states navigate this uncharted territory with agile and flexible ideas that offer alternatives to cumbersome legacy Medicaid Management Information Systems (MMIS).

DecisionPoint for Provider Services enables your state to:

  • Ensure only qualified providers, who are free of financial misconduct, are allowed to serve state beneficiaries
  • Provide a simplified approach to establishing and maintaining an efficient relationship with a qualified provider network
  • Establish an effective process of provider risk segmentation, assessment and site-based confirmation that ensures integrity
  • Create the flexibility to accommodate future health initiatives like increasing beneficiary participation in and utilization of managed care

Our solution enables states to implement a new slate of enhanced functionality without the limitations of the claims processing model within their MMIS. This supports the expansion of and improved utilization by managed care populations, and modernizes provider management functions. It can be deployed quickly and adapt to changing requirements, including future health care mandates and state initiatives.

DecisionPoint for Provider Services also includes self-service functionalities, like a provider portal, electronic document submission and payment options, which are all backed by well-trained customer service representatives, enrollment specialists and outreach staff to assist providers who may encounter problems or need assistance.