Michigan-Illinois partnership moves Medicaid provider screening to the cloud

New system addresses fraud concerns with a faster screening process and claims alerts
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A multi-million dollar project between Michigan and Illinois has moved each state's Medicaid system to the cloud, which could offer better fraud detection mechanisms.

After announcing the joint effort to build a new system for enrolling and screening providers in 2013, the claims system went live late this year, according to the Lansing State Journal. The cloud-based system allows the two states to share one infrastructure.  

The firm that built the system, Client Network Services Inc. (CNSI), told the Journal that the provider screening process that used to take more than a month has been reduced to a matter of seconds. Furthermore, providers are screened against all U.S. databases, rather than just those within the state.

The Government Accountability Office (GAO) has previously called on the Centers for Medicare & Medicaid Services (CMS) to do more to improve both beneficiary and provider enrollment screening within Medicaid programs. A report earlier this year found that Medicaid paid 2.8 million to 90 physicians with a revoked license in 2011. CMS initiating new rules allowing states to use Medicare's Provider Enrollment Chain and Ownership System to screen providers, but states have complained about limited access to that information.

The GAO also found physician enrollment failures in the Medicare screening process thanks to hundreds of invalid addresses. This year, Medicaid's improper payment rate jumped from 6.7 percent to 9.8 percent.

CNSI indicated the new system may improve fraud detection since patients will be alerted when a claim is filed under their name allowing them to quickly identify and report services they never received.

To learn more:
- here's the Lansing State Journal article

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