It’s a new year, but the same old problem.

At pie Health, we work directly with state Medicaid programs to enroll providers, resolve enrollment discrepancies, and support accurate participation in public healthcare networks. And while the calendar turns, many of the operational barriers providers and credentialers face remain unchanged.

We understand why automation exists. We recognize that automated phone systems and portals are intended to help—not hinder—providers and the credentialing partners who support them.

But recently, while attempting to resolve a provider-related issue with Wisconsin Medicaid, we encountered a breakdown that deserves attention.

Our credentialing team worked through each of the pre-selected options in the provider services phone system. None of the available paths addressed the situation we were calling about. After exhausting those options, we requested to speak with a live agent.

The system refused.

Instead, we were instructed to call back later or use the online portal. The call was then disconnected.

No agent.
No escalation path.
No immediate resolution.

To be clear, we do have access to a designated contact. But that access is not real-time. Representatives are not always immediately available, and responses can take days. In many credentialing and enrollment scenarios, waiting is not a neutral outcome. Timing matters. Decisions made—or delayed—can impact provider participation, claim submission, and patient access.

This is where rigid automation creates real risk.

Credentialing and enrollment work often involves situations that do not fit neatly into scripted menus:

  • complex provider and group structures

  • nuanced enrollment or linkage issues

  • fraud-prevention or identity-verification questions

  • scenarios where selecting the “closest” automated option introduces downstream errors

In these cases, automation does not reduce workload. It shifts risk downstream.

Wisconsin Medicaid, like all public healthcare programs, is entrusted with safeguarding public funds, preventing improper billing, and ensuring timely access to care. When experienced credentialers cannot reach a knowledgeable human being at the moment an issue arises, accuracy and accountability suffer.

We recognize that these systems were implemented with good intentions. But automation requires ongoing reassessment. When it is not revisited, it drifts away from real-world use. Over time, that drift creates a perception problem—not necessarily that the organization does not care, but that it may no longer be closely listening.

Perception matters.

Especially in light of recent events across the healthcare and insurance landscape, payers and public programs are under increasing pressure to demonstrate responsiveness, transparency, and trustworthiness. For many providers and their partners, the phone system is the front door. When that door cannot open at the moment help is needed, confidence erodes.

Insurance organizations invest heavily in branding that emphasizes care, access, and compassion. To maintain credibility, the operational experience must reflect those same values. The heart of the system needs to match the language on the website and the promises made to providers and patients.

Automation should support Medicaid operations—not replace the ability to engage a trained person when judgment, context, or discretion is required.

A clear, reliable path to timely human support is not a luxury.
It is an operational necessity.

Call transcript: provider services phone interaction

(edited only for clarity; names anonymized)

System:
“Thank you for calling ForwardHealth Provider Services. Calls may be recorded. Multi-factor authentication is now required for the secure provider portal.
If you are calling about long-term care enrollment, say ‘LTC waiver.’
I can help with claim status, prior authorizations, eligibility, provider payments, or provider enrollment. Say one of these, or ask a specific question.”

Caller:
“I need to speak to an agent, please.”

System:
“So I don’t transfer you to the wrong place, what are you calling about?”

Caller:
“I’m calling about something that requires a human.”

System:
“I’m still not sure where to send you.
For claim status, press one.
Prior authorizations, press two.
Eligibility, press three.
Provider payments, press four.
Provider enrollment, press five.
Or tell me what you need.”

Caller:
“I need to speak to a human being, please.”

System:
“Alright. Please call back when you have the information or visit the provider portal.
Goodbye.”

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