Jul 14, 2026 – By Nilay Patel, Executive Vice President and General Manager Despite a dip when COVID-era provisions ended, Medicaid enrollment continues to go up. In 2024, Medicaid enrollment increased by about 30% since February 2020. And in March 2026, the Kaiser Family Foundation shared that the Medicaid/CHIP enrollment reported by the Centers for Medicare & Medicaid Services (CMS) enrollment has increased by just over 4 million people since 2020, despite large swings during the pandemic period. Many states struggle to attract and retain providers in their Medicaid networks. In the face of a growing Medicaid population, to provide the care members need, it is crucial that State Medicaid Agencies (SMAs) do whatever they can to enroll providers of the right types, in the right places, to care for their clients. One way to do this is to make the enrollment process as frictionless as possible by selecting the right enrollment platform. Efficient, easy provider enrollment is the first step to ongoing provider engagement It’s crucial to have healthcare providers available to care for Medicaid clients wherever and whenever they need it. SMAs can take steps to meet providers where they are by making enrollment as simple and straightforward as possible. This sets the stage for a strong, ongoing relationship with providers. Here are 4 steps SMAs can take when choosing an enrollment platform to promote a robust network and provider engagement: 1. Make enrollment as streamlined as possible As the number of patients outpaces the number of providers, they are having to take on larger and larger patient loads. Plus, providers have growing administrative burdens, and they are already tasked with enrolling with multiple different payers. Providers are stressed and busy, so it is essential that Medicaid enrollment processes are understandable, require minimal effort, and are processed and approved quickly. The SMA’s first impression with a provider is during the enrollment process, which set

Jun 30, 2026 – By Nilay Patel, Executive Vice President and General Manager, HealthTech Systems When you hear the words "claim denial" or "encounter processing," it's easy to assume that the organization handling those transactions is making decisions about a person's medical care. In reality, claims and encounters processing occurs after healthcare services have already been delivered. Claims and encounters processing is fundamentally different from clinical decision-making. Understanding this distinction is important for healthcare providers, Medicaid members, policymakers, and the public. What Are Claims & Encounters? After a patient receives healthcare services, providers submit official documentation so they can be paid for the care they have already delivered. What is a Claim? A claim is a request for reimbursement, or payment, submitted by a credentialed healthcare provider. It includes information such as: The services provided Dates of service Diagnosis and procedure codes Provider information Patient eligibility details Claims are reviewed to ensure they meet program and policy requirements, comply with applicable regulations, and contain accurate information before the payment is issued. What are Encounters? Encounters differ from claims. They document healthcare services provided to beneficiaries enrolled in managed care plans. Unlike traditional fee-for-service claims, encounter data helps states and health plans track services delivered, monitor program performance, and meet reporting requirements. Important note: Both claims & encounters are administrative records of patient care for services that have already occurred. Acentra Health’s Role in the Claims & Encounters Process Acentra Health offers a Claims, Encounters, and Financial Management Solution that helps state and federal healthcare programs, such as Medicaid and Medicare, process large volumes of claim and encounter records accurately and efficiently. Acentra Health’s technology solutions autom

Jun 25, 2026 – By Nilay Patel, Executive Vice President and General Manager, HealthTech Systems Medicaid agencies are operating in a shifting environment. Federal oversight is increasing. Provider shortages continue to strain access. Program integrity expectations are rising. At the same time, states are being asked to modernize operations, reduce administrative burden, and protect public funds without disrupting care delivery. Against this backdrop, the Centers for Medicare and Medicaid Services (CMS) has directed states to strengthen provider revalidation through enhanced verification, risk-based oversight, and more comprehensive implementation planning. For Medicaid leaders, this is more than another compliance requirement. It is a test of whether provider management systems, data, and workflows are prepared to support the next phase of Medicaid oversight. Provider Revalidation Is Now a Provider Management Challenge Historically, provider revalidation has been viewed as a periodic administrative task. Today, it affects nearly every aspect of Medicaid operations, including: Program integrity Provider enrollment and credentialing Network adequacy Provider directory accuracy Payment accuracy Beneficiary access to care As expectations evolve, provider revalidation is becoming part of a broader provider management strategy designed to maintain trusted provider networks while safeguarding public resources. For Medicaid leaders, this is a program accountability issue. For technology officers, it raises questions about system flexibility, automation, and data quality. For procurement, it highlights the need for solutions that can adapt as policy and operational requirements change. Data Quality Drives Effective Oversight Strong provider management starts with trusted provider data. Many agencies still manage provider information across multiple systems and workflows. When data is incomplete, outdated, or inconsistent, states may struggle to prioritize risk, maintain accurate provider d

May 8, 2025 – By Nilay Patel, Executive Vice President and General Manager, HealthTech Systems Across the country, Medicaid programs face growing demands for greater agility, stronger compliance, and better overall experience for the people they serve. In this environment, the state of Utah has emerged as a blueprint for what is possible when vision, technology, and strategic partnership align. Utah’s recent Centers for Medicare & Medicaid Services (CMS) certification of its modernized Provider Reimbursement Information System for Medicaid (PRISM) represents more than a technology achievement. It signals that the future of Medicaid systems is modular, data-driven, and built on thoughtful collaboration. Achieving CMS certification is a rigorous process that signifies the gold standard for clinical and operational excellence. Certification is not simply a milestone to reach. CMS certification is a federal vote of confidence that a state’s Medicaid Enterprise System meets the highest performance, security, and compliance standards. Earning that trust through transparency and integrity is critical in today's environment. PRISM was developed through close collaboration between Utah's Department of Health and Human Services (DHHS) and the Acentra Health team, with Acentra Health’s evoBrixSM platform to support key Medicaid functions such as provider management, claims processing, member eligibility, and financial reporting. The final CMS certification validates the last major release, which included claims and related modules, and completes a multi-phase rollout. And the results speak for themselves. Since August 2024, the system has maintained 99.5% production uptime and achieved a perfect record of error-free federal data submissions. These outcomes are critical benchmarks that protect data integrity and help avoid the compliance risks that can arise from reporting gaps. The larger story is about the intentional design choices and commitment to stewardship that made these results

Sep 9, 2024 – By Nilay Patel, Executive Vice President and General Manager, HealthTech Systems With more than 74.6 million enrollees, Medicaid is one of the largest healthcare programs in the U.S. Yet, outdated systems pose challenges to meeting the growing demands of Medicaid populations. Today, Medicaid accounts for one-sixth of all healthcare spending and half of long-term care spending, making it a large share of state budgets.¹ This significant financial commitment underscores the critical need for efficient, modernized systems. Recognizing the limitations of its older infrastructure, the Utah Department of Health and Human Services decided to overhaul its Medicaid system completely. This effort, recently discussed at the 2024 Medicaid Enterprise Systems Conference (MESC), provided valuable insights into how Utah’s successful implementation could serve as a model for other states facing similar challenges. Ensuring Success Through Rigorous Testing & Certification One key step in Utah’s system overhaul was its rigorous approach to testing and quality assurance. The state implemented a multi-phase testing strategy – including parallel testing and user acceptance testing (UAT) – to ensure every aspect of the new system was thoroughly vetted before going live. Did you know? Utah’s testing process involved around 30,000 test scenarios. This thoroughness was essential to identifying and addressing potential issues early, minimizing disruptions during the transition. Utah executed a three-month soft launch period before the official go-live date to ensure a seamless transition. This phase involved extra validation, comparing the new system against the legacy system to verify all functions. This careful approach allowed Utah to identify and resolve discrepancies, ensuring a smooth rollout. Another key component of Utah’s success was the early adoption of CMS certification processes. By engaging with these processes early, Utah maintained alignment with federal requirements, ensu