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Highlights from the Gainwell Listening Session Held on January 17th

On Tuesday, January 17th the Office of Maine Care Services and their vendor, Gainwell Technologies, held a listening session for Maine Care providers. The session began with a Provider Enrollment Presentation, where MaineCare and Gainwell provided details about the circumstances and types of cases that require enrollment or re-enrollment and the present backlog in processing these cases. Gainwell shared information on the status designation of cases, what the terminology means, and whether a new case can be submitted or updates can be made to a current case. Currently, you can only have one open case per NPI number at any given time, given the limitations of the portal.  

Then MaineCare and Gainwell listened to concerns and comments from attendees in person at the Augusta location and those who joined virtually. A detailed question-and-answer document will be provided in the coming weeks. Additionally, the Office of MaineCare Services sent out this memo Attention Providers: Please Respond to Enrollment Cases That Need More Information (NMI) today.

Angela Westhoff, President and CEO of MHCA, attended the listening session. She provided an overview of the concerns that long term care providers have and offered suggestions for improvement, including:

  • MaineCare and Gainwell should meet with MHCA to discuss concerns/ trends and that the association can help communicate with providers. 

  • Create and promote training for staff to decrease error or incomplete submissions on the front end of the process and MHCA to assist with getting the word out about training. 

  • Gainwell should provide a Phone Help Line and live technical assistance/ support.

  • Develop multiple pathways for reviewing cases depending upon the number of work objects, and have a funnel to address provider enrollment/ re-enrollment with fewer work objects so that they are not getting stuck behind larger cases, thus adding to the backlog.

  • Gainwell noted that they will be engaging in “aggressive outreach” to help address cases that are categorized as “NMI or needs more information.” Ms. Westhoff noted that staffing is not adequate to process the backlog, let alone provide aggressive and timely outreach. She also noted that perhaps a navigator could help process cases and answer provider questions about length of time and what information may be missing or incomplete and causing delays.

Gainwell has hired additional staff to try and address the backlog and to reduce inventory of cases. They have pledged to be more strategic with case management and to introduce mitigation steps to prevent future occurrences of backlogs. 
Providers can reach out to Gainwell at 1-866-690-5585 or email: mainecaresupport@gainwelltechnologies.com
 
Staff contact: awesthoff@mehca.org

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