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Program announced to change Medicaid managed care-provider credentialing in Kentucky

 Kentucky Hospital Association President Nancy Galvagni testifies before a legislative committee  10-19-23
Kentucky Hospital Association
Kentucky Hospital Association President Nancy Galvagni testifies before a legislative committee on Oct. 19, 2023.

Three of Kentucky’s six Medicaid managed care organizations are participating in a newly established Kentucky Health Alliance. The program is aimed at streamlining the credentialing process medical providers use while working with MCOs.

Kentucky Hospital Association President Nancy Galvagni said it means providers can do this once instead of contacting each Medicaid managed care group.

“A provider comes in, fills out one application and it's reviewed for credentialing for all three plans, obviously that’s going to reduce administrative burden by a lot for those providers. As you reduce that administrative burden, it helps our plans to reduce their costs as well,” said Galvagni.

Galvagni noted efforts are underway to see if the other three Medicaid managed care organizations will join the Alliance. She added MCOs use credentialing to assure sound medical care.

“Those organizations have to have an adequate provider network as part of the quality process of making sure it quality providers they are required to credential these providers to verify their license to look at their performance,” said Galvagni.

Leitchfield Senator Stephen Meredith has filed legislation previously to lower the required Medicaid MCOs from six to two. Galvagni said the hospital association supports that move as a way to further reduce bureaucratic expenses.