The Centers for Medicare and Medicaid Services, Center for Medicaid and CHIP Services (CMCS), is announcing the launch of the CMS Provider Screening Innovator Challenge. The goal of this challenge is to improve capabilities for streamlining operations and screening providers to reduce fraud and abuse. Specifically, the contest supports the development of a multi-state, multi-program provider screening application capable of risk scoring, credentialing validation, identify authentication, and sanction checks, while lowering burden on providers and reducing administrative and infrastructure expenses for states and federal programs.
Competitors are asked to develop artifacts and components of software applications that can be compiled into an open source solution that can deliver a reliable, scalable, and economic provider screening capability for multiple states (or even the nation).
The primary goals of the application are:
- Reduced processing and transaction time for submitting and receiving queries to authoritative data sources regarding provider credentials and sanctions.
- Reductions in time needed by providers to submit information and resolve discrepancies.
- Administrative/infrastructure savings from a multi-tenant provider screening solution.
- Improved availability of key provider data relevant for program participation and oversight.
- Improved timeliness and accuracy in provider participation, oversight, and enrollment decisions.
- Improved ability to implement ACA provisions relating to provider screening in Medicaid and CHIP.
- Assist in better driving alignment of the MITA framework to the Information and Technology Architecture levels.
High Level Requirements
- Capability to Conduct Identity Verification
- Capability to Build Provider Profiles
- Capability to Evaluate and Maintain the Integrity of the Results
- Improves Efficiency
- Meets Architectural Guidelines
- Integrates Into the MITA Framework – Is MITA Complianta. Information regarding MITA can be found at: http://www.cms.gov/MedicaidInfoTechArch/
- Accurate, Cost Effective, and Timely