NC Medicaid Transformation

The NC Medicaid Transformation project is a comprehensive reform of the state's Medicaid program aimed at improving the quality of care, reducing costs, and creating a more sustainable program. The transformation includes a shift from a traditional fee-for-service model to a managed care model, in which private health plans are responsible for managing and coordinating care for Medicaid beneficiaries. The goal of the transformation is to improve patient outcomes, promote better care coordination, and reduce overall healthcare costs.

The Medicaid Enterprise System (MES) is a collection of computerized systems and applications that support the state's Medicaid program. MES is responsible for managing Medicaid claims, benefits, provider enrollment and credentialing, and other administrative functions required to operate the program.

The MES is designed to improve the efficiency and effectiveness of the Medicaid program by leveraging technology to streamline processes, reduce errors, and improve accuracy and timeliness. The system also ensures compliance with federal regulations and requirements related to Medicaid administration.

MES includes several different systems and applications, including North Carolina's Medicaid Management Information System (MMIS), which is the primary system for processing Medicaid claims and payments. Additionally, MES includes systems for provider enrollment and credentialing, pharmacy benefit management, and data analytics and reporting.

Implementing a project of this magnitude requires the expertise and the agility of a skilled contingent workforce, that's were Greensboro Staffing Consultants comes into play.  We were brought in phase 1 of the implementation to focus on preparing for the transition to a managed care model. This phase involved developing new policies and regulations, selecting managed care organizations to administer the program, and establishing new payment models and quality metrics.

The second phase of the MES implementation began in 2019 and focuses on the deployment of the new MMIS system. This phase involves designing, building, testing, and deploying the new system, as well as training end-users and providing ongoing support and maintenance.

The third phase of the MES implementation, which is currently underway, focuses on ongoing improvement of the Medicaid program. This phase involves monitoring and evaluating the performance of the new system, identifying areas for improvement, and implementing new policies and procedures as needed.