HUMAN SERVICES DEPARTMENT

1. HUMAN SERVICESDEPARTMENT • Single portal entry to become a Medicaid Provider • Application receives Real Time Approval and Notification is sent • PROCESS PHASE • 1 • 2 • 3 • 4 • Provider begins the interactive enrollment process • Provider will be sent alerts • Provider requires assistance with application, and will receive notification of additional requirements and/or documents pending clarification • Application is approved and notification is sent to MCO's, FMA, Provider, and any other external State entities • Provide Legislative and/or Federal updates, notification regarding expiring licenses, etc. via email or mobile • Process Step • Provider can directly access the portal or can hyperlink from any state or external websites • Provider will begin entering and uploading the relevant documents • Process Description • Provider will create log in credentials to begin the enrollment process. • Provider enters all information and all relevant documents, confirms the application, and submits successfully. Based on unique information (e.g. NPI, Tax ID) the portal can receive data from external data sources such as CMS, NPES, SAMS, LEIE, PECOS, DEATH Master file, Public Regulation Commission (PRC). The Provider will be asked if services were previously rendered, if yes, the Portal will request the date of service to ensure that the enrollment date covers DOS. If no, the Provider will move to next step. Portal will provide a real time status via the Progress tracking status bar. Depending on Provider Type, required documents will be prepopulated based on information submitted. The provider will set up Electronic Funds Transfer (EFT) information during the provider enrollment process • Provider requires assistance with specific steps which will be resolved by mouse-over guidance, assistance via chatbot or live chat with a CCSC agent. Once assistance is rendered and provider understands what they need, the provider will submit application. • Notification will provide issues that need to be addressed. Notification will direct Providers to the portal to complete and correct enrollment application. The State, MCO's and CCSC will also receive notification regarding the Provider enrollment status in the event that the Provider reaches out for assistance. Once all information has been addressed and corrected, the application may be submitted. • The Notification will also indicate if a site visit is required to complete the enrollment process and State staff will be notified so that scheduling of site visits can begin. All pertinent agencies will have access to information on the portal via log in credentials. • Application will be approved for BHSD, MCO's and NM Medicaid simultaneously. Provider is notified of approved application and is instructed to verify with MCO's that Provider is active in MCO system prior to rendering services. In the email notification, the provider will receive information regarding billing instructions via hyperlink which will include access to chat bots for FAQs. Billing instructions will also provide information regarding Electronic Data Interface (EDI). BHSD will be notified that the site visit will need to be conducted for certain specialties. The notification will direct Providers to resubmit claims if claims were previously denied due to "Provider not enrolled." • Providers will receive alerts regarding certifications, new federal or legislative requirements, new documents, regulations, or expiring licenses. The alerts will also provide the ability to communicate with Providers regarding billing trends, such as increase denials. • Responsible • Accountable • Consulted • Informed R A C I • HSD/DO • BHSD • RAC • I • Fiscal Management Agent (FMA) • RA • RAI • RA • RA • PPB • RAC • RA • CYFD • RAC • I • MCO • RAI • RAI • RA • Handoffs (Internal Staff) • 0 • 0 • 1-3 • 0 • 0 • Touch points • 0 • 0 • 1-2 • 0 • 0 • Systems Involved • Unified Portal w/tracking capabilities, Chat Bot, Live Chat, Text, Email, • Unified Portal w/tracking capabilities, CMS, NPES, SAMS, LEIE, PECOS, DEATH Master file, EFT, PRC • Unified Portal w/tracking capabilities, Call reference number (CRN), Email, Phone, mouse-over guidance, assistance via chatbot or live chat, PRC • Unified Portal w/tracking capabilities, chat bot, EDI, email, Benefit Management System (BMS), MCO systems, Dashboard, Text notification • Unified Portal w/tracking capabilities, email, Benefit Management System (BMS), MCO systems, Dashboard, Text notification • Staff time (All entities involved) • 0.5 • 0 • 1-2 • 1-2 • 0

2. Mission #1 One Portal Solution The journey redesign workshop generated solution ideas that could be implemented to improve the client escalation and inquiry experience • Persona based questions (e.g., questions a persona is likely to know the answer to) guides providers through wizard application (like turbo-tax "have you had a baby?" …etc.) • All providers submit through one portal. Streamlining steps so that all departments, external entities and MCO receive information when the single, common application is submitted and can process enrollments in parallel • Embedded customer services (e.g., call-back or chat) within application allows provider to quickly have questions answered by a human / bot who knows exactly where and how they got stuck) • Reporting capability to measure application numbers on a weekly basis (e.g., reasons for RTPs, complaints, partially completed applications) • Add a HSD phone tree (e.g. provider selection) for enrollment help if provider gets stuck (i.e., NOT “Director’s Office") • Automatically approved application (e.g., when probability of approval is very high) • Auto-population of address, county, zip based off credentialing / license data for a MAD 335 only. • If provider has already rendered service, claims that need to be paid can be submitted and will be automatically adjudicated once application is complete. New provider enter dates of service, beneficiary and other information for claims to get paid once enrollment is approved. • Progress tracking bar for application process available for providers via email, txt or login - Realtime • Timely interface with all internal / external entities (MCO, CYFD, DOH, BHSD) to validate and share information • Mouse over for additional info on all forms • Timeline of process (projected time to completion) provided to applications with weekly communication from Conduent / responsible entity providing updates and application status • One quality check only … not multiple overlapping quality checks by different entities • Electronic signature certification (i.e., "no blue ink") • Unified interfacing portal • Auto-approval w/o manual intervention • Provider and MCOs provide input for decision that impact them MMISR Impacted Quick Wins

3. Mission #2 Simplify Process The journey redesign workshop generated solution ideas that could be implemented to improve the client escalation and inquiry experience MMISR Impacted Quick Wins

4. Mission # 3 Provider Education and Training The journey redesign workshop generated solution ideas that could be implemented to improve the client escalation and inquiry experience • Quick reference “How to videos” similar to YouTube Tutorials will include MCOs and external entities • Survey for alerts … identify which alerts providers would like to receive • How-to videos / webinar for provider training • Alerts selection tracking legislative / rules changes to fee schedules, new codes, etc • Notification of application approval via email / txt / portal • Enrollment report to all staff as FYI • Mobile app that allows providers to access portal and receive provider alerts • Reports that can ID provider lacking in a geographical area for outreach to find local providers or to trigger telemedicine outreach / access • Utilization reports as a proactive way to determine which services are lacking • Aligning of approval date for billing • Pop-up notifications and alerts within the application to highlight differences between FFS and MCO enrollment process • Interactive training for providers • Automatic approval of applications vs. multiple, sequential approvals • Reports to look at MCO stats, loop around for MCO action plan and recommendations for avoiding enrollment challenges • Align on Dates with Policy team as relates to previously rendered services. • Feedback for high % of claim denials • Revamp Welcome letter with instruction regarding Managed Care billing.

5. Mission # 3 Provider Education and Training The journey redesign workshop generated solution ideas that could be implemented to improve the client escalation and inquiry experience Process Changes1 • Reporting capability to measure application numbers on a weekly basis (e.g., reasons for RTPs, complaints, partially completed applications) • Revise provider training to improve understanding of application process • Quick reference guides w videos / links for address changes, EFTs, FAQs etc. • Revamp Welcome letter with instruction regarding Managed Care billing. Organizational Changes2 • MCO provider specific education and training System changes • Add a HSD phone tree (e.g. provider selection) for enrollment help if provider gets stuck (i.e., NOT “Director’s Office") • TAD process auto generated / initiated by the interface once application complete

6. Ten actions have been identified to enable the near-term changes to measurably improve the client and staff experience