Wade Health Consulting, LLC

  Medicaid is one of the most complex and highly regulated healthcare programs in the United States. For providers and healthcare organizations participating in Medicaid lines of business (LOBs), credentialing is an administrative step. Credentialing determines their eligibility, compliance, and reimbursement. What does it mean by Medicaid Lines of Business ? Medicaid lines of business refer to the various coverage models under which Medicaid services are delivered. There may be Fee-For-Service (FFS) Medicaid, Managed Care Organizations (MCOs), Medicaid Managed Long-Term Services and Supports (MLTSS), and Children’s Health Insurance Program (CHIP) (in Medicaid-administered states). Each line of business may have slightly different participation and credentialing expectations. However, all operate under federal and state oversight led by Centers for Medicare & Medicaid Services (CMS). Medicaid and credentialing Credentialing verifies that providers meet professional, l...