Support Patient Finances to Impact Health Outcomes
Identify Program-Eligible Members
Focus on those not claiming entitled benefits
We use predictive analytics and machine learning capabilities to develop an eligibility scoring model to identify members who are potentially eligible for social program enrollment. We confirm eligibility and help unenrolled members through the application and submission process.
We are experienced in helping patients claim benefits in a variety of programs, including Supplemental Security Income, Medicaid, Medicare Advantage, Medicare Part D, and dual-eligibility programs for senior members.
Increase Member Revenue Potential
Enrolled members earn higher capitation rates
Members who are enrolled in social programs (partial/dual eligibility, Social Security disability, etc.) generally earn more revenue for a plan through higher capitation rates. Enrolled members also receive additional health benefits, leading to improved health outcomes, greater financial stability, and reduced cost of care for health plans.
Reduce Uncompensated Care & Improve Collections
Uncover coverage sources for self-pay patients
Eligibility and Enrollment Advocate provides support for enrolling patients in funding programs. Our onsite staff consults with patients to determine their potential eligibility for enrolling them in government funding sources at the federal, state, and local levels to secure payment. Eligibility and Enrollment Advocate also helps ensure timely and accurate reimbursement of motor vehicle accident (MVA) and workers’ compensation claims, and helps to educate patients on available programs and assisting with application submissions.
Improve Patient Satisfaction & Loyalty
Impact your STAR ratings
Our personalized approach helps patients by addressing their most critical needs. We provide a hands-on approach that ensures each patient feels supported every step of the way.
When your most vulnerable patients receive the extra financial support they need and deserve, their health outcomes begin to improve. Patient satisfaction and loyalty also rises, which can lead to better STAR ratings for your hospital, health system, or health plan.
Solutions We Provide
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