Frequently asked questions

Are your patient eligibility services and software HIPAA compliant?

Yes. Our services and software protect patient privacy and adhere to all HIPAA regulations as well as site-specific procedures and compliance standards.

Can you ensure our patients will be served with dignity and respect?

Yes. Our on-site staff work as advocates for your patients and are committed to supporting them with empathy and empowering them with education. Our one-on-one, face-to-face interactions with your patients greatly increase patient loyalty to your organization and improve patient engagement.

How can your patient eligibility solutions help our patients?

Our top goal at EligibilityAdvocates is to help you support your patients through patient advocacy. Our patient eligibility service reduces or eliminates patients’ out-of-pocket costs, identifies financial assistance opportunities and manages the application process for patients, provides patient financial counseling and education, and alleviates patients’ financial confusion and stress.

We also offer ED staffing and expanded hours compared to most eligibility and enrollment services (we have on-site patient advocates available at a minimum of 12 hours/day, 6 days/week), helping to ensure your patients find support when they need it. You can learn more about how we help patients here.

How can your patient eligibility solutions improve our revenue cycle?

EligibilityAdvocates reduces uncompensated care and write offs by exhausting all possible funding sources for patient accounts. We verify insurance benefits in real-time and find unreported insurance coverage, screen for financial assistance, charity, and public benefits eligibility, and manage out-of-state Medicaid claims. And because our on-site patient eligibility service operates face-to-face and at a minimum of 12 hours/day and 6 days/week, we see higher conversion rates, increased point-of-service payments, and overall improved patient collections.

With EligibilityAdvocates, your facility or health system will always be the “payer of last resort.”

Additionally, our pre-arrival workflow solution streamlines financial clearance and prevents errors that lead to denials, reimbursement delays, or rework.

Will we have to replace our current EMR/EHR system or other technology?

No; there is no need to lose your investment in your current technology. Our software can integrate with all the major EHR/EMR platforms and work seamlessly with HL7, FHIR, DirectQuery, data feeds, and custom APIs.

How do you price your patient eligibility services?

We offer contingent fee pricing – you only pay for our services when you get paid!

Can you bill out of state Medicaid?

Absolutely, there are specific guidelines that must be met, but we take care of everything from getting the physician and hospital enrolled to billing and following up on the claim until payment is secured or denial. If a denial can be or should be reconsidered, we handle the appeals process up to final denial.

Is the provider enrollment process efficient, and are applications being handled in a timely manner?

This is dependent upon the provider and our company working together to be successful. We do need documents and signatures from the provider and/or facility and are reliant on receiving these documents back in their entirety to proceed. Personal and sensitive information (home address, social security number, drivers license, place of birth, etc.,) is needed from physician and board members, which often is difficult to obtain, especially when working within a paper application. Given that the requirements vary from state to state, there is no master resource and each state varies dramatically.

Can we email referral's directly to the Provider Enrollment team?

Yes, can send referrals via email directly to your point of contact.

How long will an enrollment usually take once you receive the referral?

This can vary depending on the State . This can take anywhere from 30 days to 6 months.

Will you enroll with the Medicaid HMO's?

Yes, if we receive a referral in which an enrollment with the HMO is required.

  • Payor contracts may require practices to notify them within 30 days of a provider’s termination (resignation, retirement, etc.), but many practices forget to do so.
  • As new plans are added by a payor, credentialed providers may not realize they need to opt-in to participate.
  • Payor contracts may require providers to opt-out of plans or they will automatically be included in them.

How will you obtain the necessary information required to complete the enrollments?

We will request facility documentation upon initiation of contract and will request Physician information only if an enrollment is required.

Why should we partner with EligibilityAdvocates?

EligibilityAdvocates is the new standard in patient eligibility. Our higher performance standards entail:

  • Extensive coverage of at least 12 hours a day and 6 days a week
  • Emergency Department staffing
  • Mobile screening software for bedside eligibility screening and in-field advocacy
  • Forms automation
  • Face-to-face interactions with patients
  • Automated patient outreach messaging
  • ALL accounts are worked across EVERY area (e.g. IP, OP, ED)
  • All unlinked accounts are closed within 30 days

In merging cutting-edge technology with the personal touch of our expert, on-site patient advocates, EligibilityAdvocates delivers the perfect balance of automation and human interaction needed to maximize your patient advocacy efforts and improve your revenue cycle.