Laws & Regulationsout of state medicaidRevenue cycle

Why Outsource Out-of-State Medicaid Billing? 

By January 8, 2021 No Comments

EligibilityAdvocates Blog

Why Outsource Out-of-State Medicaid Billing?

Posted on January 8, 2021

If you’re struggling with out-of-state Medicaid enrollment and/or billing in-house, it may be time to consider an alternative solution. Outsource out-of-state Medicaid enrollment and billing to a performance-based company that specializes in these claims.

Here are the top reasons to outsource out-of-state Medicaid enrollment and billing:


1. Lack of internal resources.

Like many healthcare organizations, you may choose to write off out-of-state Medicaid accounts rather than allotting time and resources to working these complex claims. However, you are missing out on a substantial form of reimbursement that could improve your revenue cycle while reducing aged receivables.

2. Lack of expertise in complicated out-of-state Medicaid claims requirements.

If you have tried to manage these difficult claims internally, you’ve probably found that they require more time and expertise than your staff can reasonably deliver. EligibilityAdvocates specializes in out-of-state Medicaid and we handle all the work necessary for reimbursement. This includes enrolling providers and facilities in states’ Medicaid programs, billing and submitting claims, following up on any delayed claims, and appealing denials. We devote our time and extensive resources to all aspects of the out-of-state Medicaid process so your teams can focus on other objectives.

3. No standardization – there are over 50 Medicaid programs.

A map of the United States illustrates the 50+ Medicaid programs that we will monitor for you when you outsource out-of-state Medicaid work to EligibilityAdvocates.

EligibilityAdvocates is knowledgeable in all 50+ Medicaid programs.

Each state, U.S. territory, and Washington, D.C. has its own Medicaid program with different and continually changing rules. Additionally, there are new and temporary Medicaid flexibilities to navigate due to COVID-19 and these vary by state as well. When you choose a partner who is proficient in every Medicaid program, you don’t have to keep track of all these moving parts – we do it for you.

4. Occurrence is increasing, Medicaid Expansion, and Americans love to travel.

Even in light of COVID-19, a recent survey of over 30,000 Americans found that 46% are ready to travel once lockdowns are lifted. Expansion and the increase of Medicaid patients accessing care outside their enrollment states will continue to grow for hospitals in the future.

5. Return on investment – move to performance-based contingent fee pricing.

It’s difficult to realize a positive ROI when a facility manages, enrolls, and/or bills out-of-state accounts. Switch to a performance-based resource. There are no up-front costs OR facility enrollment fees when you outsource out-of-state Medicaid work to EligibilityAdvocates. You only pay for our services once we’ve delivered results and the hospital has received payment.

6. Improve A/R and see an increased remittance.

Our out-of-state Medicaid specialists have the knowledge, experience, and technology to provide you with quicker reimbursement, at a higher rate. EligibilityAdvocates combines out-of-state Medicaid experts with workflow automation technology to streamline claims resolution management.

7. Look to EligibilityAdvocates to expand your revenue cycle team with no increase in internal labor costs.

EligibilityAdvocates is a performance-based partner that serves as an extension to your revenue cycle team. By partnering with us, you can ensure your out-of-state Medicaid accounts are settled without the need to hire additional staff to work them. You won’t have to train new employees, add them to your payroll or benefits programs, or pay for any extra office space and equipment (desks, computers, phones, etc.). These are fixed expenses, regardless of how much money your staff actually collects. Conversely, when you hire EligibilityAdvocates you’ll only pay us as much as our performance warrants.

Outsource Out-of-State Medicaid Billing


You may not have the time and resources needed to work out-of-state Medicaid claims, but you can’t afford to lose out on this valuable source of revenue either. The simple solution is to outsource out-of-state Medicaid work to an external billing company like EligibilityAdvocates.

Protect your revenue without the hassle – outsource out-of-state Medicaid billing to EligibilityAdvocates today.


By EligibilityAdvocates

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