Provider Enrollment and Credentialing in Medicaid

Medicaid provider enrollment and managed care credentialing aim to ensure that Medicaid enrollees receive care from qualified providers. As part of the Commission’s continued focus on access to care for Medicaid enrollees, MACPAC examined federal and state policies as well as academic and grey literature pertaining to Medicaid provider enrollment and credentialing. In this session, staff presented a draft chapter that summarizes findings from that work. The presentation outlined federal requirements for provider enrollment and credentialing and provided an overview of those processes. Staff then discussed provider enrollment requirements for select provider types and challenges that emerged from the literature.