A new developer's challenge sponsored by the Centers for Medicare & Medicaid Services (CMS) seeks software applications that can be used across multiple states and programs to screen healthcare providers. The contest starts May 30 and will run through October or November, according to a CMS announcement in the Federal Register. Total prize money available will range between $500,000 and $600,000.
CMS said the development of such apps would streamline operations and reduce fraud and abuse.
Applications submitted for the challenge should be able to verify provider identity, validate physician credentialing and check for sanctions against physicians, while also reducing the burden on providers to submit information and resolve discrepancies. Improved availability, timeliness and accuracy of provider data is expected to lower administrative and infrastructure costs for state and federal programs.
While CMS sponsors the contest, the National Aeronautic and Space Administration will administer the challenge through its Federal Center of Excellence for Collaborative Innovation, which was formed to use new methods, such as crowdsourcing and open innovation, to solve agency problems.
One of the goals of the innovation competition is to drive better alignment of the Medicaid Information Technology Architecture (MITA) 3.0 framework to information and technology architecture levels.
The latest MITA version incorporates new technologies, such as cloud computing, and federal requirements for increased Medicaid enrollment and interoperability in the health reform law.
Among the capabilities that the application should be able to perform:
- Use a graded screening method that intensifies checks for providers flagged as high risk.
- Build provider profiles that can retain information and results and compare them against past and future screenings.
- Incorporate enhanced screening data, including results of site visits, criminal background checks and fingerprinting.
- Create a learning system to make sure that negative trends factor back into screening rules in order to flag suspicious enrollments early in process.