Medicaid Eligibility

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Partner with our multilingual Medicaid experts and increase the opportunity of recovering revenue by uncovering missed opportunities. Whether an initial submission or a second sweep, our team utilizes skills and resources to work with even the most complex cases. Our multilingual Medicaid experts streamline the Medicaid redetermination process by proactively conducting outreach programs to beneficiaries, providing reminders and application assistance.

We help your organization navigate complex eligibility criteria and documentation requirements efficiently. Our team’s in-depth understanding of state-specific eligibility rules and procedures enables us to make quicker and more precise determinations.

Explore our solutions below.

The Opportunity

RateAnalyzer™

RateAnalyzer™ is a powerful solution utilizing standardized and cleansed price transparency data from machine-readable files, offering hospitals and health systems a competitive edge in negotiating favorable payer contracts. Learn more →

Good Faith Estimates

Our solution automates the burdensome process of manually building an itemized Good Faith Estimate for self-pay or uninsured patients and is available for use for out-of-network patients to generate an itemized cost estimate and signed notice and consent. Learn more →

RateAnalyzer™

RateAnalyzer™ is a powerful solution utilizing standardized and cleansed price transparency data from machine-readable files, offering hospitals and health systems a competitive edge in negotiating favorable payer contracts. Learn more →

Good Faith Estimates

Our solution automates the burdensome process of manually building an itemized Good Faith Estimate for self-pay or uninsured patients and is available for use for out-of-network patients to generate an itemized cost estimate and signed notice and consent. Learn more →

Day-1 Outsourcing

Medicaid Eligibility Services for Providers – Day-1 Outsourcing

Our patient advocacy approach to Medicaid Eligibility provides on-site point-of-service financial screening for self-pay patients to qualify and enroll them into federal and state Medicaid programs. We combine our vast experience and Medicaid program knowledge with data analytics to explore every opportunity to ensure that patients get their appropriate coverage and our clients receive appropriate payments for services. We screen, investigate and assist in the identification/qualification process for all patients.
Our efforts include:

Field representatives for home visits
Document interpretation and collection
Meetings with state and federal agencies as patient advocates
Meeting with on-site hospital staff for a transparent and accountable process

This service assists facilities in reducing self-pay patients by enrolling eligible patients into a Medicaid program, leading to added revenue from accounts that were potentially written off to bad debt or charity care. Our process looks at enrolling all of your self-pay population, leading to an improved patient experience with increased revenue potential.

With experience in both expansion and non-expansion state Medicaid processes, KA Consulting is also certified application counselor (CAC) organization under the Affordable Care Act, which enables us to enroll patients in the Affordable Care Act insurance exchange.

Second Sweep

Second Sweep Medicaid Eligibility Service

We help you identify revenue that would have been lost due to gaps in the eligibility process. This service also includes a complete assessment of these files to improve the eligibility process and minimize missed revenue opportunities.

Our professionals examine bad debt or charity care files (depending on the state) and find applicable programs to qualify patients. Using our qualifying techniques, we find patterns in hospital data that identify additional eligibility opportunities. Furthermore, we perform a complete assessment of these data files and identify any and all Medicaid eligibility process gaps that could be costing your facility revenue. Our Second Sweep Analysis gets patients entitled benefits and reduces providers’ bad debt/write offs, a win-win for all parties.

Out of State Medicaid Services

Out-of-state Medicaid Services

Our KA Consulting Division offers a suite of services to assist your organization in obtaining Medicaid coverage for out-of-state patients. We free your staff from this resource-driven process so they can concentrate on other tasks where they can be more efficient and productive.

Our solutions include:

Out-of-state patient eligibility screening and enrollment
Provider program enrollment support
Medicaid out-of-state billing

Is your organization looking to outsource the Medicaid eligibility screening and qualification process? With Panacea as a partner, you will be assured that every eligibility opportunity is pursued for patients to receive appropriate coverage. The incorporation of the Virtual Eligibility Counselor (VEC) in our enrollment process has resulted in industry leading conversion rates.

Virtual Eligibility Counselor

Reduce enrollment barriers, increase access and supplement staffing.

The Virtual Eligibility Counselor (VEC) provides the patient experience of an on-site Medicaid enrollment process with the benefits and convenience of providing the same process in a virtual setting.

By providing this process virtually, the patient and the hospital can benefit from the elimination of on-site enrollment barriers including language, time constraints and transportation.

In addition, our data shows that implementation of the VEC can increase Medicaid enrollments, by improving application completion, supplementing staff and increasing access to maximize enrollment.