Eligibility and Advocacy Services
Many patients struggle to get the assistance they need, while you are struggling with revenue loss. Our patient advocates can help.
Our specialists operate on a proactive platform designed from our extensive knowledge of third-party recovery programs and processes, and years of interacting with indigent populations, medical providers and government agencies. With advanced technology and a highly trained staff, we can increase Medicaid eligibility certifications and reduce processing time for Medicaid, SSI and other federal, state and local programs for you and your patients. Our team has deep experience and knowledge of Medicaid regulations and state-specific programs nationally.
Increase reimbursements
In addition to better Medicaid outcomes, our specialized staff is trained to find all alternate sources of reimbursements, such as state-specific programs, COBRA, and Social Security Disability.
Enhance patient satisfaction
Each patient has a dedicated team from start-to-finish who receive robust training and coaching so that your standards and community standing are upheld. Our team also has strong people skills that support our patient-first approach.
Improved data exchange and front-end functions
We offer an improved automated exchange of data to and from client systems, and through our highly targeted process, to ensure that the right information is gathered on cases most likely to be certified.
CASE STUDY: Service in action
Case Study:
The Issue
A large acute care hospital, a pediatric hospital and a small community hospital within a well-known national health system were all struggling with a loss of revenue due to an underperforming eligibility vendor.
The Action
We deployed a team to establish relationships with local Medicaid agencies, created new processes, trained new patient advisors and coordinated departments.
The Result
The hospitals experienced a 53% increase in paid Medicaid accounts and more than one-third improvement in patient screening days.
Screenings are conducted on all potentially eligible individuals, with a strong focus on connecting with patients on-site to maximize results. We evaluate eligibility, based on state guidelines and a five-step sequential evaluation used by the Office of Hearings and Appeals. Advanced technology and analytics enable staff to focus time interacting with patients with the highest likelihood of certifications.
We gather all supporting documentation for each case, follow up with appropriate government offices and ensure that each application or appeal for government assistance is supported by medical evidence and professionally generated correspondence. We work closely with the hospital staff to ensure all relevant information is incorporated in case development.
Each client has a dedicated team and our teams regularly undergo robust training and coaching. We provide you a monthly review of key performance indicators and other reports, and monthly benchmarking and feedback regarding all aspects of eligibility services.