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Provider Solutions

Flexible pathways. Simplified provider management. Improved Medicaid outcomes.

A smiling doctor in a white coat holds a stethoscope up to the heart of a pre-teen girl patient who is smiling as her mother in a green shirt smiles in the background.

Simpler. Smarter. Statewide and beyond.

CMS has raised the bar on provider oversight and states can’t meet it with manual processes and siloed data. Gainwell Provider Solutions cuts through complexity with flexible modernization that strengthens compliance, prevents fraud upstream, and delivers better provider experiences. Modernize incrementally with Provider Flex™, replace legacy systems with Provider+™ or extend your reach across state lines with Provider Everywhere™, the first cross-state provider intelligence network. Every path supports revalidation, integrates screening into the provider lifecycle, and improves visibility into potential risk signals.

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15 Minutes

Application Completion Time

24 Hours

Approval Turnaround

90%+

First Pass Application

Solutions designed to improve experiences and streamline operations.

Gainwell Provider Everywhere™

Connect your state to a shared provider data network that improves cross-state visibility, supports revalidation efforts, and strengthens program integrity.

Gainwell Provider Flex

Enhance capabilities gradually according to your priorities and budget with our phased approach to provider service modernization.

Gainwell Provider+

Transform your providers’ experiences and improve operational efficiency with our best-in-class, fully modular provider management replacement.

Centralized Credentialing

Reduce provider burden and administrative cost through a shared, NCQA-accredited, and scalable centralized credentialing platform.

Customer Experience

Personalized, seamless, and omnichannel interactions with contact center staff equipped with state-of-the-art technology and training.

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Additional solutions making healthcare more efficient and effective.

Medicaid Enterprise

Modernizing claims, encounters, and financials with intelligent automation and interoperability through Gainwell Enterprise™.

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Care Quality

Enabling quality care and affordability with strategies that balance empathy and efficiency.

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Data & Analytics

Transforming your most complex data into actionable insights with Gainwell Genius™.

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Actionable insights that
empower healthcare progress.

We’re passionate about delivering ideas that can help shape the future of
healthcare, using education and transparency to improve health outcomes for all.

Expert Roundtable: Expanding Care Access by Enhancing the Provider Experience

Expert Roundtable: Expanding Care Access by Enhancing the Provider Experience

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Redefining Provider Enrollment Compliance and Accuracy in Puerto Rico

Redefining Provider Enrollment Compliance and Accuracy in Puerto Rico

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Empowering Providers, Powering Medicaid - A Playbook for Friction-Free Provider Experiences

Empowering Providers, Powering Medicaid – A Playbook for Friction-Free Provider Experiences

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Explore All Insights

How can we support you?

Remove provider management friction and ensure CMS compliance with flexible solutions that meet your transformation goals.

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Is Your State Ready for What CMS Expects Next With AI?

Federal mandates are accelerating. Interoperability deadlines are here. AI is no longer optional — it's an operational imperative. This 3-minute diagnostic reveals where your Medicaid program stands across the five dimensions that matter most.

15 questions · 5 categories · Takes ~3 minutes