EnCred Project: Indiana Healthcare Enrollment & Credentialing System

1. FSSA EnCred Project Indiana Health Coverage Programs Conduent Business Services, LLC. 2019 Spring Provider Workshop

2. Agenda • EnCred Project Background, Overview, and Status • EnCred Project Timeline • EnCred Functions • Provider Enrollment and Credentialing Process • EnCred Demonstration • FAQs • Questions

3. EnCred Project Background

4. Background • HEA 1007 provides for the development of EnCred that adds new statutory language in Ind. Code 12-15-11-9 • This gives the Indiana Family and Social Services Administration (FSSA) the authority to develop and implement a centralized verification organization (CVO). EnCred is FSSA’s solution to that requirement • Nearly 80% of the 1.4 million IHCP members receive care through one of four managed care entities (MCEs). Currently, connecting the 50,000 Indiana Health Coverage Programs (IHCP) providers with these members involves a fragmented and sequential enrollment and credentialing process that is not consistent with the State’s desire for efficient government services • Right now, providers must first submit an enrollment application to IHCP. Then, after a successful enrollment, a provider must submit a credentialing application to each MCE. After becoming credentialed (up to four times), the provider can begin the contracting and enrolling process for each MCE to provide services to members within each MCE’s network • The current process requires the provider to be accountable to IHCP for Medicaid enrollment information and accountable to each MCE for credentialing information • The FSSA EnCred project was developed to create a singular, unified IHCP enrollment and credentialing process with one point of accountability for all providers • The State has contracted with Conduent, Inc. (formerly Xerox/ACS Human Services) to design the EnCred solution for IHCP providers

5. Terms and Concepts • Enrollment - the act of enrolling to become an IHCP provider • Credentialing - the process where verification of education, training experience expertise and willingness to provide services is performed • NCQA sets these processes and methods for validation • FSSA EnCred (EnCred) - a single enrollment and credentialing process for IHCP providers • Credentialing will occur during the enrollment application process for those providers required to be credentialed

6. EnCred Project Status

7. Project Status • Currently in the development phase • Finalizing the data interfaces with external stakeholders (e.g. DXC, Managed Care Entities (MCEs), Pharmacy Benefit Manager (PBM - Optum Rx), Southeastrans (SET), and the State’s Enterprise Data Warehouse (EDW)) • Continue monthly provider status and update meeting to provide updates and answer questions • Continue transition planning activities between EnCred team and DXC • Established the EnCred Provider Workgroup, comprised of a variety of IHCP provider types • Workgroup will be trained to utilize and test the EnCred system and contribute feedback on the provider experience as end users of the solution • Next Steps: Testing Phase

8. EnCred Project Timeline

9. Current EnCred Project Timeline

10. EnCred Provider Enrollment “Black-Out” Period • In order to allow sufficient time for enrollment applications and updates to be completed prior to the EnCred implementation date, a provider enrollment “black-out” period is necessary • The “black-out” period will be approximately 30 days • All provider enrollment applications or updates (paper and portal) will need to be received prior to the start of the “black-out” period • The applications and updates functionality will not be available via the IHCP provider portal after the start of the “black-out” period • Paper applications postmarked on or after the “black-out” period start date will be returned to the provider to apply via EnCred *Watch for additional details on the IHCP “black-out” period in future publications

11. Provider Enrollment and Credentialing Process

12. Current IHCP Enrollment and Credentialing Process Provider Smith  IHCP Provider Application IHCP Provider Enrollment Stop Approved Separate Applications, generally similar information Approved MDwise Provider Credentialing Provider Smith MHS Provider Credentialing Approved Stop  Approved Anthem Provider Credentialing Approved CareSource Provider Credentialing

13. Future EnCred Enrollment and Credentialing Process Provider Smith IHCP Provider Credentialing/ enrollment  Stop Approved MDwise Provider Contracting CareSource Provider Contracting MHS Provider Contracting Anthem Provider Contracting

14. EnCred Benefits • Reduced duplication: EnCred eliminates the need to update provider information in more than one place • Streamlined application: Application will include both enrollment and credentialing data fields • E.g. will include additional fields from a CAQH application (education, work history, etc.), if applicable • Increased accuracy: EnCred will be the single source of truth for provider information, accessible through the IHCP portal by providers and delegates • Time saving: • Intend to enroll and credential providers (unless exceptions exist) within 30 days • Only one application (including credentialing information) is submitted, instead of five, to become enrolled and credentialed in IHCP • Only one verification of information is required, instead of five • A centralized committee will be utilized instead of four separate MCE committees • E-signatures will allow providers to attest at any time from any location • Increased efficiency with MCEs: Once providers are approved to participate in IHCP, they can begin the process of contracting/enrolling in MCE network • Technological improvement: EnCred can accommodate larger attachment upload sizes

15. EnCred Functions

16. Important EnCred Functions • Provider maintenance: • Revalidate/re-credential provider enrollments • Enroll a new service location • Link a rendering provider to a group enrollment • Update a provider profile • OPR to rendering conversions • Change of ownerships (CHOWs) • And more!

17. EnCred Re-attestation Process and Timeline • Re-attestation: Providers who need to credential as part of the enrollment process will be required to re-attest to their information every 120 days • When providers re-attest, they are attesting that all the information in the application is current, true, and accurate • This is separate from CAQH re-attestation. CAQH data is currently only credentialing and not enrollment • Providers can submit applications via paper; however they can only re-attest electronically

18. EnCred Revalidation and Recredentialing • A schedule is being developed to align revalidation and recredentialing dates to a single date, once every three years • Providers will be notified of their new date via the standard 90, 60, 30 day notification process

19. Important Changes after EnCred Go-Live • All rendering providers must establish an IHCP account • Any time there is an update to provider information (i.e. address, other information), it will require the provider to re-attest • Note: This is due to the combining of enrollment and credentialing together • EFT - EnCred will consume initial EFT information during the application process; however all maintenance/changes of EFT information must be submitted via the IHCP portal and also directly to the MCEs • Revalidation and re-credentialing date alignment

20. EnCred Demonstration

21. Focus of Demonstration • Initiating an application • As a new provider • As an enrolled provider • Maintenance activities • Re-attesting process • How to upload documents (up to 10MB)

22. New Provider

23. IHCP Provider Portal

24. EnCred Home Page SIGN UP

25. Create Account

26. Login

27. Provider Dashboard

28. New Application

29. Application Navigation Layout • Additional information on general navigation tabs available on the next slide.

30. Application Navigation Detail • General Information – general provider information such as name, address, and phone number • IHCP Program Participation – additional programs that providers can sign up for (i.e. MRT, PASSR) • Professional IDs – medical licenses, medical certifications, CLIA, and DEA • Specialties – Medicaid/Medicare specialties and board certifications • Education and Training – education and training information • Healthcare Facility Affiliations – any healthcare facility you have a relationship with • Professional liability – malpractice insurance and claims information • Work History – employment history • Practice information – schedule C disclosures, service locations, services provided, patient acceptance – are you accepting new patients • Addendums – IHCP Addendums; completed only for certain provider types and specialties (such as MRO clubhouse) • Disclosures (only required for credentialing) – Credentialing disclosures, anyone not eligible for credentialing will not see this tab • Audit – audit feature to re-review all information prior to attestation

31. Audit • Application Documents - examples include DEA registration certificate, licenses, and proof of insurance • Payment - where provider selects criteria to meet the application fee requirement • Application Checklist - helps to ensure all required information has been completed • Attestation - digital signature to ensure information provided is true/correct

32. Audit - Application Documents • Application Documents - examples include DEA registration certificate, licenses, and proof of insurance DEA DEA registration certificate Medical License Medical Liability Cover Sheet

33. Audit – Payment • Provider will select one of the options to meet the requirement for the application fee

34. Audit – Application Checklist • To help the provider make sure a complete application is submitted, these links are provided to show where required fields have been missed. This speeds up the processing after submission.

35. Attestation • After clicking Next, the provider will be able to sign the application electronically. EXAMPLE

36. Enrolled Provider

37. Where Enrolled Providers begin • The provider will login to IHCP Provider Healthcare Portal

38. Where Enrolled Providers begin • The provider will click on Provider Maintenance

39. Provider Dashboard Active

40. General Information Application Navigation Layout • Existing providers can utilize the navigation tool bar to make changes to their enrollment.

41. Audit - Application Documents • Application Documents - examples include DEA registration certificate, licenses, and proof of insurance DEA DEA registration certificate Medical License Medical Liability Cover Sheet

42. Audit – Application Checklist • To help the provider make sure a complete application is submitted, these links are provided to show where required fields have been missed. This speeds up the processing after submission.

43. Attestation • After clicking next, the provider will be able to sign the application electronically. EXAMPLE

44. Re-attestation

45. Where Enrolled Providers begin • The provider will login to IHCP Provider Healthcare Portal

46. Where Enrolled Providers begin • The provider will click on Provider Maintenance

47. Provider Dashboard • The provider will click the manage button to select the enrollment to attest Active

48. Re-attestation • To begin re-attesting, the provider will click on the re-attest button

49. Re-attestation • To review and validate information, the provider will “click here” • Then, the provider will click on “Attestation section” to continue

50. Attestation • After clicking next, the provider will be able to sign the application electronically. EXAMPLE