Unraveling the Maze: Tackling Out-of-State Medicaid Claims and Credentialing Challenges

Healthcare IT Today November 13, 2024
Guest Author

The following is a guest article by Crystal Campbell, Director Out-of-State Medicaid at Aspirion

For healthcare providers, managing out-of-state (OOS) Medicaid claims can feel like traversing a regulatory minefield. While Medicaid typically does not cover non-emergency care received outside a patient’s home state, the realities of healthcare access in rural America have led to an increase in patients crossing state lines for treatment, especially for specialty care. This trend has created a complex set of challenges for hospitals and healthcare systems, ranging from understanding varied state regulations to navigating the intricacies of provider credentialing.

The Regulatory Landscape

At its core, Medicaid is a joint federal and state program, leading to a patchwork of rules that vary from state to state....

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