Provider Screening Module for Medicare/Medicaid Provider Enrollment

Contents:

Introduction and Current Status
Development and Installation
Project Resources and Organization of This Repository
Participating in the PSM Project
Background

SECTION 1: Introduction and Current Status

This is an open source Provider Screening Module (PSM) designed to work within a U.S. state Medicare/Medicaid Information System (MMIS) environment to provide a portal for screening service providers as part of the provider enrollment process. It is released under the Apache-2.0 open source license. Please see the project home page at ProjectPSM.org for an overview.

This code is a work-in-progress and is not yet ready for production deployment.

See the "Background" section below for more about the provenance of this project.

SECTION 2: Development and Installation

Development activity takes place on the master branch, with short-lived development branches used for specific tasks. Code contribution guidelines are in CONTRIBUTING.md.

Please feel free to file issue tickets in this repository to ask questions.

Please see INSTALL.md for how to install an instance for development or demonstration.

Note that the PSM depends a separate application, CAV ETL, to communicate with certain external data sources, e.g., federal databases such as LEIE, Social Security DMF, PECOS, etc. CAV ETL used to be a semi-separate middleware application contained within the PSM (in the old ext-sources-app subdirectory code), providing a service wrapper around external data sources. Now it is a standalone middleware application, meant to be accessible not only to the PSM but to other MMIS modules as well.

SECTION 3: Project Resources and Repository Organization

Please see INSTALL.md for the latest installation instructions.

See DESIGN.md for an overview of the PSM's architecture and design assumptions.

The psm-app subdirectory holds the source code to the PSM proper.

ProjectPSM.org is the project home site, where we publish the user manual as well as documentation for the PSM's web API.

See also the section "Participating in the PSM Project" below.

SECTION 4: Participating in the PSM Project

Please see CONTRIBUTING.md, in particular the section "Communicating with the PSM Project" at the top.

SECTION 5: Background

The NASA Center of Excellence for Collaborative Innovation (CoECI) through an Interagency Agreement with the Centers for Medicare and Medicaid Services (CMS) administered a crowd-sourced application development challenge for the Medicare and Medicaid Services, Center for Medicaid and CHIP Services (CMCS). The challenge was to build a multi-state, multi-program provider screening application capable of risk scoring, credentialing validation, identity authentication, and sanction checks, that lowered the burden on providers and reduced administrative and infrastructure expenses for states and federal programs.

The application was built using NASA's contract with Harvard Business School in association with the Institute of Quantitative Social Sciences and their subcontract with TopCoder. The Application Development Challenge was sponsored by CMS as part of the Partnership for Program Integrity Innovation program with the specific intent of developing an application to improve capabilities for streamlining operations and screening providers to reduce fraud and abuse.

The challenge was comprised of an omnibus of 120 contests launched between June 2012 and April 2013, to cover all phases of the software development life cycle. The code and documentation resulting from that challenge are hosted in an original repository code, from which this repository was cloned to continue the project. Work restarted in April 2017.