OK! You Are Now Contracted with Medicaid Managed Care Organizations (MCOs)! So, Where does Your Organization Go from Here?!
The dust is settling….. the Medicaid MCO credentialing & contracting frenzy is now a distant (or not so distant!) memory for many behavioral health agencies. So where do you go from here?
Much of your organization’s energy will now be focused on Practice Management. Practice management includes such things as making sure the MCOs have the most up to date staff rosters or that new sites are credentialed and added to your Agreement. It also includes ensuring your staff has access to the MCOs’ Provider Manuals that contains important information relevant to their respective departments. In short, it is time to “operationalize” your MCO Agreements.
But a more fundamental Practice Management question that also needs to be answered is does your organization understand what MCO product lines they contracted for and how do those various product lines operate?
Many MCOs included your organization in more than just their Medicaid and MyCare product lines. Unfortunately, most organizations were only concerned with these two product lines (and rightfully so as it represents a significant part of their client base) and did not pay attention to the other product lines. But not understanding how the other product lines operate could potentially cost your organization valuable resources (including reimbursement).
This is the law of unintended consequences.
I highly recommend that you “re-visit” the provisions in your executed agreements and make sure that you obtain clarification on any area that is considered “grey” or confusing. Your organization must understand how the other product lines operate so that it can accommodate clients covered under these plans.
Organizations cannot assume that these product lines will operate the same way that their Medicaid/MyCare lines of business operate (in terms of reimbursement, eligible providers, covered services).
At Pinnacle Partners, we have over thirty six years of experience in the managed care arena. We understand the complexities of contracting and know what questions to ask in order to assist our clients in minimizing the unintended consequences of MCO contracting.
Please let us know we can be of service to your organization as you continue your journey into this new world!