Provider Services Solution (PRSS)

Provider eligibility determination and enrollment processes. Automated provider enrollment functions track and report provider applications throughout the provider enrollment process, providing a process that is as efficient and accurate as possible to encourage participation of qualified providers. Activities also include credentialing and source verification from appropriate licensure, certification, or other authorities to support DMAS participation criteria and requirements. The Provider Services Solution will also operate a provider enrollment help desk and Provider Portal to access needed information, submit forms, and perform a variety of functions. Maintaining details about the provider in a master database that interacts with other components within the MES Modular Core Services Solutions and other systems, to adequately process and pay claims for services to eligible members and other functions.