Frequently Asked Questions

What is the Provider Screening Module project?

The Provider Screen Module project is a Federal and State partnership to pilot Open Source module development, including piloting models for procuring, developing, and maintaining shared modules. The goal is to produce a fully functional, configurable module that vendors and States can freely incorporate into their systems.

Why does the Provider Screening Module exist?

Screening providers is currently a manual process in several states. All states need to screen providers against the same Federal databases, so providing a reusable, modular provider screening solution can be very beneficial. Screening is also comparatively simpler to separate from the rest of the Medicaid Managment Information Systme (MMIS), so it makes a great initial target to pilot.

Who could benefit from using or joining the Provider Screening Module?

States:

Vendors:

What is a Provider Screening Module?

When providers apply to participate in the Medicaid program, States need to screen providers in accordance with Federal and State regulations. Provider applicants are screened against several Federal exclusion lists, including the List of Excluded Individuals/Entities (LEIE), Death Master File (DMF), and the Excluded Parties List System (EPLS). The applicant’s provider license is also checked. Screening is necessary to verify that providers are qualified to care for Medicaid patients.

Where did the Provider Screening Module project come from?

The Provider Screening Module started as part of a crowd-sourced challenge through Topcoder back in 2012. The resulting implementation was evaluated by Minnesota and South Carolina, but was not adopted. From 2016 to 2017, the Centers for Medicare and Medicaid Services (CMS), with help from MITRE and Solution Guidance Corporation, resumed the project, performed a gap analysis on the existing implementation and developed a minimum viable pilot.

How can I contribute to the Provider Screening Module?

There are a few ways you can contribute to the Provider Screening Module:

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