Modernize your Medicaid Enterprise System
Valuepoint program is helping states streamline the procurement process. ValuePoint uses resources from multiple states to create cooperative agreements.
States are looking to modernize their Medicaid Enterprise Systems. The ValuePoint Master Agreements for the MMIS-Provider Services Module can help. It reduces procurement timelines with established pricing, pre-selected solutions and vetted core functionality.
We help states have a successful NASPO contracting experience
Provider Enrollment and Self-Service Portal
This portal makes it easy for providers to enroll and manage their submissions. Its core foundation is the provider database, which securely stores all data. The verification workbench tool directs enrollment documents to the right queues for thorough review.
Option 1: Improve business service operations
Option 1 includes full-service outsourced provider management. This includes end-to-end support for operations, call center services, provider site visits and training to enhance your network.
Option 2: Enhance self service capabilities
Option 2 provides real-time member eligibility and claim status inquiries, warrant and remittance advice inquiries, appeals and online direct entry claims.
Key benefits
For states seeking to modernize their Provider Services module, the ValuePoint lead-state model provides a host of benefits.
Robust performance standards
Robust performance standards are already in place, and we bring a management framework that is built on proven processes, tools and best practices with a focus on quality and lessons learned.
Comprehensive terms and conditions
Take advantage of an established master agreement tailored to meet core Medicaid agency needs for managing providers. Enhance with Participating Addendums for state-specific requirements.
CMS pre-approval
Core functionality has already been vetted by other states and the Centers for Medicare & Medicaid Services.
Pre-defined costs
With ValuePoint you get a pre-defined pricing structure for core functionality and options, implementation and operations.
Reduced procurement/acquisition timeline
The lead state model serves to expedite the procurement and contracting process while still providing the flexibility to account for the specific needs of participating states.
Federally compliant and configurable
Our pre-approved solution is federally compliant and can be configured to address state-specific laws and policies.
States may join with a participating addendum
We’ll help you navigate the Participating Addendum process for a successful NASPO contracting experience.
An experienced partner
We have integrated many lessons learned into our approach, which helps states have a successful NASPO contracting experience.
Learn more about our Provider Management Services Module
Explore the ValuePoint website to view our Participating Addendum.
Optum Provider Services Module FAQ
The NASPO framework offers pre-screened qualified vendors and ensures initial CMS buy-in. This covers some basic groundwork for requirements. But it limits flexibility for unique needs and doesn't fully address the complexity of modular integration.
To overcome these challenges, some states have successfully expanded on the NASPO framework to tailor it to their specific needs. Organizations can keep the advantages of NASPO by changing the framework. This also lets them better meet their unique needs.
Before transitioning from a legacy system to a modular system, take these important steps.
- Establish a strong system integrator to ease the modularization process.
- Make a detailed plan for an Enterprise Service Bus or a centralized integration platform. This will ensure smooth communication between different modules.
- Make sure all modules can integrate seamlessly and manage all inter-dependencies effectively.
- Secure full buy-in, support, involvement and cooperation from the legacy system vendor to ensure a smooth transition. This means making it clear who's responsible for what and when. This can be done directly with vendors or through the SI.
For a successful implementation, it's important to establish clean data agreements up front. Also establish a firm production go-live date and clear data conversion timelines. Keep the legacy system for historical data but switch to new processes for future enrollments.
Granting read-only access to legacy systems helps the new vendor understand state-specific business rules. Extensive testing is crucial. Use at least 2 years of production data, expand testing scopes, and implement automated test scenarios. A Beta Go-Live with the client before involving the provider community can preemptively address issues.
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