Provider Data Management Credentialing Verification Organization Solution

The Vendor is required to provide provider data management credentialing verification organization solution (PDM/CVO) module will support a web-based self-service tool for providers to electronically sign and submit enrollment applications, complete periodic updates of their enrollment information, and revalidate provider record information.
- Self-service portal
• Allow providers and potential applicants to learn and understand the process for submitting applications, viewing and updating their data, completing revalidations, and completing any activities required as part of the PDM/CVO solution.
• Allow enrolled providers to review and manage demographic data associated with their records.
• Include other self-service functions necessary to support day-to-day business functions, including but not limited to; a provider inbox, interactive chat functionality, and a provider locator for both public and authenticated users to find actively enrolled providers based on specified criteria.
- Provider maintenance
• PDM/CVO module must support provider maintenance activities for external and internal users that are founded on business process driven workflow automation principles.
• These activities include the collection, storage, and maintenance of all provider information identified for the operation of the Medicaid enterprise system (MES).
• It also requires ongoing, automated provider monitoring necessary to support state healthcare programs business objectives and must be compliant with federal and state statutes, assurance, policies and mandates.
- PDM/CVO solution will consist of the below high-level items:
• Consolidate all provider data to reduce administrative redundancy for providers.
• Simplify enrollment, data maintenance and revalidation processes.
• Facilitate centralized credentialing on behalf of department payers and health plans.
• Potentially mitigate reimbursement errors caused by outdated provider data.
• Allow for delegated enrollment and credentialing.
• Aligning state credentialing process with assurance standards.
• Establish a representative centralized credentialing committee with representatives from department payers and health plans.