A community of hands forms a heart shape around the words “Eligibility REDEFINED.”

Eligibility REDEFINED: EligibilityAdvocates Sets the New Standard in Patient Eligibility

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EligibilityAdvocates Blog

Eligibility REDEFINED:

EligibilityAdvocates Sets the New Standard in Patient Eligibility

Posted on Tuesday, June 1, 2021

At EligibilityAdvocates, we are redefining patient eligibility and enrollment. Our Patient Advocates are raising the bar with higher performance standards, increased patient engagement, and (above all) a heartfelt commitment to patients, hospitals, and their communities.

Read on to learn how we go above and beyond to help our clients and their patients!


Eligibility REDEFINED: The EligibilityAdvocates Difference


A community of hands forms a heart shape around the words “Eligibility REDEFINED.”

EligibilityAdvocates is Eligibility REDEFINED.

On-Site Patient Advocates – Many other patient eligibility companies assist patients via email and phone or transitioned to conducting business remotely this past year. But even during the height of the pandemic, our Patient Advocates met in person (including home visits) with patients to help them obtain health coverage and/or financial assistance and other benefits.

We implemented extensive safety precautions to make this possible to ensure our clients’ patients were able to access the eligibility services they needed – and at a time when many were especially in need of this help. Our face-to-face interactions with patients build trust and result in higher conversion rates.

Expanded Coverage Hours – Patients need help outside of the typical Monday through Friday, “9 to 5” workday, yet most other patient eligibility and enrollment services operate within that timeframe. Our Patient Advocates are available on site, including in the Emergency Department, to help patients at a minimum of 12 hours/day, 6 days/week – and up to 24 hours/day, 7 days/week (based on peak analysis).

Screening Rate of 90 Percent – EligibilityAdvocates screens 90% of our clients’ uninsured patients BEFORE discharge. Patients who are screened and engaged before they leave the hospital are much more likely to follow through with the benefit application process.

We further increase patient engagement through bedside screening, home visits, and in-field patient advocacy. We then follow up with patients through their preferred communication method (e.g., text, email, letter) to keep them engaged as well.

Community Impact & Outreach – Our motto is, “Impacting Communities, One Patient at a Time.” Our Patient Advocates are passionate about making a difference in the lives of patients and their communities. This means they go the extra mile to assist patients beyond their medical bills, in any way they can.

For example, our Patient Advocates have:

Additionally, we volunteer our services at community health fairs where we enroll residents in Medicaid or Marketplace insurance plans.

We also create job opportunities; our Patient Advocates are hired locally, expertly trained, and genuinely invested in the well-being of their own community.

Travel Assistance – When patients have no other mode of transportation, we can arrange for travel assistance so that they can meet in person with one of our Patient Advocates or attend a hearing at the Medicaid or Disability Office. This is provided at no cost to the patients or our clients.

All Accounts Worked – Many patient eligibility organizations focus only on the easier or high-balance cases. At EligibilityAdvocates, we work EVERY account across all areas (e.g., inpatient, outpatient, ED) and unlinked accounts are closed within 30 days. We make this commitment to pursuing the tough claims for our clients because we care about each patient and understand the impact this effort will make on your relationship with them.

Out-of-State Medicaid Services – One type of complicated claim which is frequently written off is the out-of-state Medicaid account. We can handle all aspects of out-of-state Medicaid enrollment, billing, and follow-up so that our clients don’t miss out on this substantial form of reimbursement. Our out-of-state Medicaid team has experience in all 50 states’ Medicaid programs.

Technology – EligibilityAdvocates is powered by HealthWare Systems’ patient engagement and revenue cycle technology solutions. HealthWare Systems has been a leading provider of fully integrated, customizable workflow solutions and Revenue Cycle Management software since 1998.

Our proprietary software, AdvocatorAI, is a comprehensive patient screening tool that finds existing coverage in real time and identifies alternative funding sources for patients’ medical bills while supporting patient advocacy through financial counseling and assistance. AdvocatorAI streamlines the benefit application process by producing application forms electronically and auto-populating them with patient data.

We also provide transparency of account status at all times through customizable dashboards, reports, and alerts.

Performance-Based Pricing – Choosing EligibilityAdvocates as your on-site patient eligibility and enrollment service equates to a guaranteed ROI. We offer contingent fee pricing; we are only paid once we’ve successfully helped you collect reimbursement.

Most notably, the return on investment in regard to the impact our services can have on your patients and community is invaluable. At EligibilityAdvocates, we are truly changing lives.

EligibilityAdvocates: Eligibility REDEFINED


EligibilityAdvocates merges cutting-edge technology with the personal and human touch of our expert, on-site Patient Advocates to deliver higher performance standards, increased patient engagement, and a real, lasting impact on the community.

Contact us today to start maximizing patient advocacy at your facility while improving the financial outlook of your patients, organization, and entire community.


By Stephanie Salmich

The logo of patient eligibility service and out-of-state Medicaid billing company EligibilityAdvocates.

EligibilityAdvocates – New Patient Eligibility Service Powered by HealthWare Systems

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Press Release

EligibilityAdvocates – New Patient Eligibility Service Powered by HealthWare Systems

FOR IMMEDIATE RELEASE: May 4, 2021

Elgin, IL:  HealthWare Systems has partnered with a new company, EligibilityAdvocates, which offers patient eligibility and out-of-state Medicaid billing services. The new organization is powered by HealthWare Systems’ revenue cycle technology solutions.

EligibilityAdvocates’ on-site patient eligibility and enrollment service helps self-pay and uninsured patients find and obtain health coverage and/or financial assistance. On-site patient advocates and technology facilitate real-time coverage detection, eligible program screening, and timely account appropriation.

The logo of patient eligibility service and out-of-state Medicaid billing company EligibilityAdvocates.

EligibilityAdvocates – New Patient Eligibility Service Powered by HealthWare Systems

EligibilityAdvocates provides expanded coverage hours and ED staffing and its patient advocates utilize tablets/laptops equipped with the company’s proprietary software AdvocatorAI, a comprehensive screening tool that identifies existing coverage or alternative funding sources for patients’ medical bills while supporting patient advocacy through financial counseling and assistance.

The new company also offers an off-site out-of-state Medicaid service that operates as a performance-based extension of its clients’ revenue cycle teams. EligibilityAdvocates is experienced in all 50 states’ Medicaid programs and handles all aspects of out-of-state Medicaid enrollment, billing, and follow-up so that hospitals don’t miss out on this substantial form of reimbursement.

EligibilityAdvocates reduces health organizations’ uncompensated care and account cycle time, increases self-pay conversions, and provides transparency of account status at all times through customizable dashboards, reports, and alerts.

“HealthWare Systems has always believed in creating patient-first technology and developing solutions that improve the financial outlook for all stakeholders in a health system – including patients, providers, healthcare facilities, and the entire community,” stated Steve Gruner, CEO and Founder of HealthWare Systems. “EligibilityAdvocates has created the perfect opportunity to leverage the power of our ActiveWARE products to drastically reduce patients’ out-of-pocket costs and hospitals’ uncompensated care.”

“I am proud of the EligibilityAdvocates team who have already proven their ability to rise above unprecedented challenges during the pandemic as well as their selfless dedication to patient support, especially during this time when patients and their families need it most,” said Gruner.

Jeff Woody, Chief Revenue Officer at EligibilityAdvocates, agrees and said he looks forward to sharing the inspiring stories of how EligibilityAdvocates’ patient advocates go above and beyond for those they serve:

“At EligibilityAdvocates, our motto is ‘Impacting Communities, One Patient at a Time.’ Our patient advocates are truly committed to making a difference in the life of each patient they assist, and they are able to maximize their patient advocacy with the help of HealthWare’s state-of-the-art technology that allows them to more accurately and efficiently serve patients and deliver results.”

To learn more about the patient eligibility service and out-of-state Medicaid billing company, visit www.eligibilityadvocates.com where you will find further details about EligibilityAdvocates’ services, patient resources, and an educational blog covering patient advocacy and out-of-state Medicaid issues.

About HealthWare Systems:


HealthWare Systems is a leading provider of fully integrated, customizable workflow solutions and Revenue Cycle Management software. We specialize in applying robotic process automation (RPA) to healthcare processes to improve both the patient experience and the revenue cycle. Our ActiveWARE suite of products manages pre-arrival, financial assistance, early out, collections, denial management, claims follow-up, and more, and is proven to maximize productivity and profitability so that healthcare teams have more time and resources to spend on quality care.

About EligibilityAdvocates:


EligibilityAdvocates’ patient eligibility and enrollment service utilizes technology proficiencies to enable our patient advocates to optimize one-on-one interaction with self-pay/uninsured patients to reduce uncompensated care. We provide real-time coverage verification, a comprehensive screening tool (AdvocatorAI), and expanded on-site coverage hours. We also offer an experienced off-site team to handle your out-of-state Medicaid enrollment, billing, and follow-up. Our complementary goals of promoting patient advocacy and improving your revenue cycle go hand-in-hand as we strive to create a healthier financial environment for your entire community.

Contact Information:


Name: Stephanie Salmich
Organization: HealthWare Systems
Address: 2205 Point Boulevard, Suite 160, Elgin, IL 60123
Phone: (847) 649-5100

A health insurance claim form along with the blog title – Out-of-State Medicaid Reimbursement: Top Challenges & Solutions

Out-of-State Medicaid Reimbursement: Top Challenges & Solutions

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EligibilityAdvocates Blog

Out-of-State Medicaid Reimbursement:

Top Challenges & Solutions

Posted on Friday, February 5, 2021

Out-of-state Medicaid reimbursement poses significant challenges to healthcare facilities. Many choose to write off these difficult claims. Those that attempt to work them experience success rates so low, they don’t seem worth the effort.

Fortunately, you don’t have to lose out on this valuable revenue.

Below are the top challenges to out-of-state Medicaid reimbursement along with the ways in which EligibilityAdvocates can help you solve them.

Challenge: Changing Regulations


A health insurance claim form along with the blog title – Out-of-State Medicaid Reimbursement: Top Challenges & Solutions

EligibilityAdvocates has expertise in each Medicaid program and can help solve your challenges to out-of-state Medicaid reimbursement.

It is very hard for an internal billing team to keep track of all the rules governing Medicaid because they are continually modified and vary from state to state. Each state, U.S. territory, and Washington, D.C. has a separate Medicaid program with its own requirements and processes. If you do manage to find an employee with this niche expertise, an additional challenge arises in retaining the employee or retraining someone else if you face turnover.

Solution: EligibilityAdvocates provides a team of experts who specialize in out-of-state Medicaid and every unique Medicaid program while staying up-to-date on all new laws and policies.

Challenge: Enrollment of Facility AND Providers


Before you can submit a claim to Medicaid, you must enroll your facility and providers in the specific state’s program you are billing. This is a very involved task as it typically requires gathering sensitive personal information (e.g. social security numbers, home addresses, copies of driver’s licenses, signatures) from each of the hospital’s board members and/or physicians. Even ordering, prescribing, and referring (OPR) providers for Medicaid patients must complete OPR provider enrollment.

Enrollment must be completed in a timely manner so that you don’t miss your window for reimbursement. The enrollment process and which documentation each program requires for enrollment differs by state, further adding to the difficulties. In fact, may healthcare organizations consider this the most painful step on the road to out-of-state Medicaid reimbursement.

Solution: EligibilityAdvocates completes, submits, and maintains your facility AND provider enrollment applications at no additional cost to you. Save yourself the money, time, and headache it takes to accomplish this job and simply let us do it for you.

Challenge: Billing & Follow-Up


The billing process for Medicaid also differs by state. Each program has its own claim forms, billing requirements, list of covered services, and reimbursement rates. Even a simple error like using the Medicaid billing template for your own state to submit a claim to another state’s program can result in a denied claim.

Your billing team will need to devote time to follow up on delayed or denied claims, sometimes unaware of why the claim was initially rejected.

Solution: The EligibilityAdvocates out-of-state Medicaid team has experience in all 50 states’ billing procedures. We will bill and follow up on each out-of-state Medicaid claim for you, ensuring no claim is neglected, as well as take care of the appeals process for any denied claims when necessary. Not only are our team members specialists in claims resolution for Medicaid and out-of-state Medicaid, but our Medicaid expertise and pre-arrival workflow solution also prevent errors and issues that cause denials, underpayments, and reimbursement delays in the first place – providing you with higher remittance and quicker reimbursement.

Challenge: Maintaining Qualifications & Revalidation


For each Medicaid program you wish to bill, your facility must maintain its qualifications according to the program’s requirements and your providers must complete periodic revalidation with the program(s). Failure to do so will result in deactivation with the Medicaid program and denied claims. If a provider is un-enrolled, re-enrollment will entail more time and work and there may be a gap in eligibility for reimbursement.

Solution: EligibilityAdvocates provides maintenance and monitoring of all your Medicaid credentials to prevent expirations and deactivation and to make sure you are proactively maintaining compliance with each program.

Challenge: Drain on Resources


Each of these challenges requires time, expertise, and resources that your staff may not have or that they cannot afford to take away from their other billing responsibilities. Focusing their attention on out-of-state Medicaid reimbursement is not the best use of their time and your money if they do not collect a sufficient volume of revenue.

Solution: EligibilityAdvocates is a performance-based extension of your revenue cycle team. Our services are strictly contingent, meaning we don’t get paid until we’ve delivered on our promise to get you paid. The revenue we bring in will always exceed the cost of our services and your employees can focus on other objectives while we manage your complicated out-of-state Medicaid work.

Solve Your Out-of-State Medicaid Reimbursement Challenges with EligibilityAdvocates


Outsource out-of-state Medicaid work to EligibilityAdvocates and we will take on these challenges for you. No longer will you need to assign time, energy, stress, and staff to these complex claims or write them off as bad debt.

We will handle all aspects of out-of-state Medicaid enrollment, billing, and follow-up for you, so you don’t miss out on this substantial source of revenue. Contact us today and start collecting the out-of-state Medicaid reimbursement you are due!


By Stephanie Salmich

Lengthy checklists representing the time-consuming process of provider screening are shown along with the question: How do CMS provider screening requirements affect out-of-state Medicaid claims?

CMS Provider Screening Requirements & Out-of-State Medicaid Claims

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EligibilityAdvocates Blog

CMS Provider Screening Requirements & Out-of-State Medicaid Claims

Posted on January 21, 2021

Lengthy checklists representing the time-consuming process of provider screening are shown along with the question: How do CMS provider screening requirements affect out-of-state Medicaid claims?

EligibilityAdvocates specializes in all regulations that affect out-of-state Medicaid reimbursement, including CMS provider screening requirements and state-specific procedures.

The New Year is here and it’s time for families to start traveling. With travel, come patients from out-of-state. With out-of-state patients, come out-of-state Medicaid claims.

All states have their own rules and regulations regarding Medicaid. But on March 25, 2011 the Centers for Medicare & Medicaid Services (CMS) implemented additional screening requirements for states to follow for Medicaid provider enrollment. If these requirements are not met, the provider risks termination from the Medicaid program and/or a delay in reimbursements.

How Do CMS Provider Screening Requirements Affect Out-of-State Medicaid Claims?

Here are the top 6 requirements, which can be found in the Federal Register, that affect the out-of-state Medicaid enrollment and billing process:

1.) Database Checks

Requirement: States are required to screen all providers “upon initial enrollment and monthly thereafter for as long as the provider is enrolled in the Medicaid program” (p. 5897).


2.) Unscheduled & Unannounced Site Visits

Requirement: The Secretary may carry out unscheduled and unannounced site visits. “States must conduct pre-enrollment and post-enrollment site visits for those categories of providers the State designates as being in the “moderate” or “high” level of screening.” Providers must permit the on-site visits (p. 5898-5899).


3.) Provider Enrollment & Provider Termination

Requirement: All providers must undergo screening at least once every 5 years. States are required to deny or terminate the enrollment of providers if:

  1. The provider “does not submit timely and accurate disclosure information or fails to cooperate with all required screening.”
  2. The provider is “terminated on or after January 1, 2011 by Medicare or any other Medicaid program or CHIP.”
  3. The “provider fails to submit sets of fingerprints within 30 days of a State agency or CMS request.”

States can also deny enrollment to a provider “if the provider has falsified any information on an application or if CMS or the State cannot verify the identity of the applicant” (p. 5900).


4.) Criminal Background Checks & Fingerprinting

Requirement: Each provider the State designates as within the “high” level of screening is subject to fingerprinting (p. 5901).


5.) Deactivation & Reactivation of Provider Enrollment

Requirement: Medicaid providers who have “not submitted any claims or made a referral that resulted in a Medicaid claim for a period of 12 consecutive months” must have their Medicaid provider enrollment deactivated (p. 5903).


6.) Enrollment & NPI of Ordering or Referring Providers

Requirement: The State “must require all ordering or referring physicians or other professionals to be enrolled under a Medicaid State plan or waiver of the plan as a participating provider.” Their NPI must be on applications to enroll and on all claims for payment (p. 5903).


The CMS regulations established more consistency in the screening process so that states can better ensure providers are qualified to serve the Medicaid population. However, since the CMS provider screening requirements were enacted, many providers have been discouraged to seek out-of-state Medicaid reimbursement because of the amount of work involved in the application process. Plus, on top of these standardized enrollment requirements, states vary in their rules and regulations for filing claims.

Don’t Miss Out on Out-of-State Medicaid Revenue


At EligibilityAdvocates, we are experts in out-of-state Medicaid. From CMS provider screening requirements to each state’s individual Medicaid program (and temporary waivers related to COVID-19), we keep track of all rules and regulations that affect out-of-state Medicaid reimbursement.

When you outsource out-of-state Medicaid work to EligibilityAdvocates, you can collect payment for these complex claims without devoting your time and resources to monitoring (ever-changing) federal and state regulations. We will do so for you and take care of every aspect of Medicaid enrollment for both the provider and facility, claims submission, and claims follow-up.

Contact us today to learn more about how we can help your practitioners and facility meet CMS provider screening requirements and obtain reimbursement for your out-of-state Medicaid claims – all at a performance-based rate.


By EligibilityAdvocates

A doctor completes a form on a tablet below the caption - FREQUENTLY ASKED QUESTIONS: OPR Provider Enrollment

Ordering, Prescribing, and Referring (OPR) Provider Enrollment FAQs

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EligibilityAdvocates Blog

Ordering, Prescribing, and Referring (OPR) Provider Enrollment FAQs

Posted on January 21, 2021

Even if you do not submit claims to Medicaid, you are required to complete OPR provider enrollment if you are an ordering, prescribing, and referring (OPR) provider for Medicaid patients. This requirement was implemented by the Affordable Care Act (ACA) and the Centers for Medicare & Medicaid Services (CMS).

To help you navigate this process, we’ve compiled a list of the most common questions we receive from ordering, prescribing, and referring providers regarding Medicaid enrollment.

A doctor completes a form on a tablet below the caption - FREQUENTLY ASKED QUESTIONS: OPR Provider Enrollment

EligibilityAdvocates can answer your OPR provider enrollment questions and manage the Medicaid enrollment process for you.

OPR Provider Enrollment FAQs


1) Why are OPR providers required to complete Medicaid enrollment?

Additional integrity requirements are placed on state Medicaid programs. This requirement complies with federal regulation 42 CFR 455.410 concerning the screening and enrollment of providers.


2) How do I know if I should enroll as an OPR provider?

This type of enrollment may be suitable for you if:

  • You occasionally see Medicaid recipients who need additional services/supplies that can be covered by Medicaid.
  • You do not plan to submit claims to Medicaid for reimbursement.
  • You are not enrolled as another Medicaid provider type.

3) What are the OPR requirements?

The 3 basic OPR requirements are:

  1. The provider who wrote the order/prescription/referral must be enrolled in Medicaid (either as a participating Medicaid provider or as an OPR provider) and that provider’s NPI must be included on the claim.
  2. The provider’s NPI must be for an individual physician or non-physician practitioner (not an organizational NPI).
  3. The provider must be of a specialty type that is eligible to order, prescribe, or refer.

4) Do I have to be enrolled as a participating provider or can I be enrolled only as an OPR provider?

If you will only be ordering, prescribing, and referring services for Medicaid recipients and won’t be billing Medicaid for these services, you may enroll as only an OPR provider. But if you wish to bill Medicaid, you must enroll as a fully participating Medicaid provider.

OPR providers do not bill Medicaid and are not required to treat Medicaid patients.


5) If I am already enrolled as an active provider with a state’s Medicaid program, do I also need to enroll as an OPR provider in that state?

No; anyone who is an active Medicaid participating provider does not need to enroll again as an OPR provider.


6) Is there a separate Medicaid enrollment application for OPR providers?

Yes; each state has a separate Medicaid enrollment application specifically for OPR provider enrollment.


7) If I am enrolled in one state’s Medicaid program, do I still need to enroll in other states’ programs?

If you order, prescribe, refer, or render services for a Medicaid patient, you must be enrolled in the state program to which the patient belongs. For example, if you are a provider located in California and enrolled in California’s Medicaid program and you write a prescription for an Arizona Medicaid recipient, you must be enrolled in the Arizona Medicaid program as well.


8) What will happen if I fail to complete Medicaid enrollment as an OPR provider?

The healthcare providers and facilities who deliver services according to your orders/prescriptions/referrals will not be reimbursed by Medicaid for those services if you are not enrolled and your NPI is not included on the Medicaid claims they submit.


9) If a claim is denied because the OPR provider is not enrolled in the Medicaid program, can the OPR provider retroactively enroll?

In most cases the billing provider can resubmit the claim after the OPR provider enrolls. There are state-specific claim timely filing limitations.


10) Do claims submitted to Managed Care Organizations (MCOs) have to follow the OPR requirements?

This depends on each MCO or HMO and its specific requirements.

OPR Provider Enrollment Services


EligibilityAdvocates handles all aspects of Medicaid enrollment for both OPR providers and fully participating Medicaid providers, including out-of-state Medicaid enrollment.

If you have more questions regarding OPR provider enrollment or would like EligibilityAdvocates to take care of this process for you, please contact us here.


By EligibilityAdvocates

Three people look at financial reports and the blog title appears: New Year’s RCM Resolutions

New Year’s RCM Resolutions

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EligibilityAdvocates Blog

New Year’s RCM Resolutions

Posted on Friday, January 15, 2021

While many people are eager to start a new year and put 2020 behind them, COVID-19 continues to impact healthcare facilities in numerous ways – including financially.

A recent survey of hospital executives and finance leaders found that since the pandemic started, there has been an increase in bad debt, uncompensated care, self-pay patients, and Medicaid patients for over 40 percent of participants.

In response to these challenges, we’ve listed practical actions you can take this year to protect your revenue and reduce uncompensated care.

Here are five New Year’s RCM resolutions:

Resolution #1: Financially Clear Patients Prior to Their Date of Service


Preventing errors on the front end of the revenue cycle is an ideal way to avoid payment delays, denials, underpayments, and extended A/R that contribute to bad debt.

EligibilityAdvocatespre-arrival workflow solution streamlines financial clearance activities such as order/referral management, (real-time) insurance verification, preauthorization, and (real-time) medical necessity verification. Automating steps performed by Patient Access limits deficiencies and integrity issues that have a negative impact on the revenue cycle.

Resolution #2: Ensure Your Organization Is Payer of Last Resort


Three people look at financial reports and the blog title appears: New Year’s RCM Resolutions

Set these New Year’s RCM resolutions to help you achieve your revenue cycle goals.

To reduce bad debt, it is imperative that all possible funding sources are exhausted for a patient account before it is designated as uncompensated care. There are numerous options available, including:

  • Medicaid
  • Out-of-State Medicaid
  • Presumptive Eligibility
  • Crime Victim Compensation
  • Disability – SSI/SSDI
  • Qualified Health Plan Enrollment
  • State & County Programs
  • COBRA
  • Veterans Benefits
  • Indian Health Services

EligibilityAdvocates screens patients for their eligibility in all the above using our proprietary software, AdvocatorAI.

The screening process can begin immediately, as our patient advocates are equipped with tablets and can meet with the patient at bedside or in the field and deliver instant results.

Additionally, our pre-arrival workflow solution searches for unreported health coverage and our patient advocates help patients enroll in health plans so that they are covered for future visits at your facility.

An added benefit of our technology solutions is that they facilitate a “touchless” process with patients. We can conduct the screening process with AdvocatorAI over the phone and complete financial clearance prior to patient arrival, which helps limit the number of people at your facility during the COVID-19 pandemic.

Resolution #3: Stop Writing Off Out-of-State Medicaid Claims


Out-of-state Medicaid billing is complex, but hospitals that write off these claims miss out on a substantial form of reimbursement.

If you are unable to devote the necessary time and resources to working these complicated accounts, outsource out-of-state Medicaid claims to a team of experts who can do the work for you.

EligibilityAdvocates handles all aspects of out-of-state Medicaid enrollment (for both facility and providers), billing, and follow-up. We have experience in all 50 states’ programs and our early determination and single point allocation allow for more Medicaid conversions, higher remittance, and faster reimbursement.

Resolution #4: Improve Patient Engagement & Patient Responsibility Collections


EligibilityAdvocates provides one-on-one patient financial counseling and education to help patients navigate their healthcare finances. And our in-person meetings between patients and patient advocates result in higher conversion rates, increased point-of-service payments, and the establishment of patient payment plans.

The more your patients understand the financial aspects of healthcare (such as health insurance, financial assistance opportunities, and how to decipher their medical bills), the more likely they are to pay their patient responsibility. Patient financial stress is often related to confusion over what is owed and why, which leads to delayed or non-payments.

Resolution #5: Outsource Patient Eligibility & Enrollment


You will experience a greater return on investment if you pursue these objectives with the help of an outsourced and on-site patient eligibility and enrollment service.

Managing these tasks internally requires the expenses of an in-house staff (e.g. pay, benefits, hiring, initial and ongoing training, office space, phones, computers, printers, desks). These are costs that must be paid whether employees recover an adequate percentage of revenue or not.

On the other hand, if you outsource patient eligibility to EligibilityAdvocates, we offer performance-based pricing; you only pay us a percentage of the money we collect and none of the labor costs. We also provide OP/ED staffing at up to 24 hours a day and 7 days a week, which contributes to our higher success rates.

Keep Your New Year’s RCM Resolutions with EligibilityAdvocates


When you partner with EligibilityAdvocates, we will make sure you reach each of these goals and more.

Contact us today and get started on your New Year’s RCM resolutions right away!


By Stephanie Salmich

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.

Why Outsource Out-of-State Medicaid Billing? 

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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