It’s time to rethink how we approach oversight of provider eligibility, especially within Medicaid and Medicare Advantage plans. The traditional interval approach to checking providers’ identity, credentials, and billing eligibility is time and resource-intensive. 

A smarter approach to provider eligibility and oversight empowers more complete provider network data and better, faster decisions to protect revenue and member safety.  

In this eBook, you’ll learn:

  • A new approach to provider eligibility
  • How smarter oversight can benefit multiple departments and address FWA
  • How smarter oversight can reduce claims leakage
  • Strategies for preparing provider data for interoperability 
  • Three steps to achieving continuous provider eligibility