Eligibility & Enrollment Solutions
Services for payers and providers that help to identify and support financially-vulnerable patients through payment counseling and program enrollment.
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.
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.
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.
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.