When you partner with EnableComp, you gain access to our industry-leading expertise and proprietary Intelligent Automation Platform to streamline the process and reclaim out-of-state Medicaid reimbursements for your patients and institution.
Out-of-state Medicaid claim management is an administrative nightmare for providers. With all of the rules governing Medicaid that vary from state to state, it takes a significant amount of time and expertise to keep track of all the changes. When worked internally, teams typically experience low success rates. Many choose to write them off.
We are your “department down the hall” with the resources and infrastructure to get the most out of your out-of-state Medicaid claims — whether you’re a healthcare provider of one or a healthcare system of many.
Our team of experts has in-depth knowledge of the intricacies of this niche reimbursement class. We successfully enroll, validate, check eligibility, bill, and obtain reimbursement for providers in all 50 states. We work with payers at state agencies and health plans — speaking their language and earning their respect and cooperation.
Our proprietary software platform, E360 RCM™, interfaces directly with clearinghouses and your EHR/HRIS system — updating automatically with current state fee schedules and legislative policy.
Our Provider Enrollment Team enrolls your facility and physicians in State Medicaid programs and HMO plans as required for billing. All enrollment documents are completed in full by our staff and sent to you for review and signature, making this process effortless for you. Provider numbers are updated and maintained with the states, thereby reducing provider-related claim denials.
We have your out-of-state Medicaid claims covered every step of the way.
Based on your organization’s priorities.
Proprietary Discovery Solution
We utilize extensive foundational intelligence to validate and confirm expected reimbursement.
Preparation
Automation-enhanced estimation and accuracy checks for required data and supporting documentation prior to sending to the payer.
Timely Filing
Bill is packaged and submitted electronically, when possible.
Follow-Up
Aggressive follow-up and process monitoring.
Status Documentation
Notes updated daily to ensure visibility into the status of every claim.
Payment Review
Underpaid items are identified automatically and appealed.
Denial Management
We pursue full reimbursement on your behalf and help fine-tune internal processes to prevent denials from recurring.
Appeals
We appeal when applicable as well as represent your hospital in subsequent matters when allowed.
Detailed monthly reporting based on pre-defined priorities to help you measure progress and reconcile accounts.
A comprehensive solution that works all of your out-of-state Medicaid claims from every angle for maximum impact and ROI. Ideal for providers who are ready to focus solely on higher-priority claim categories by outsourcing their OSM claims.
Your Day One Solution includes:
We start on day one and work claims from registration to reimbursement for consistently accurate and timely payments.
We inherit your open claims and manage aging accounts to a successful resolution for improved queue management and inventory reconciliation.
We help you negotiate payment with Medicaid when a patient’s bill exceeds the allowable amount.
We identify and prevent denials — providing root-cause analysis and reworking even the most complex claims to enhance revenue and yield.
Every state is different and rules are changing all the time.
What it takes to get paid.
What you need to succeed at Medicaid enrollment.
Not sure if you’re leaving money on the table? We’ll conduct a high-level analysis of your open A/R, denials, and claims that are considered “closed” and carry a zero balance.
With your RevAdvise™ consultation, you’ll gain insight into your:
Looking for some quick wins? We’ll also show you how fast you can recover that revenue.
No cost. No obligation. No risk.
Our contract is always contingent on your results.
You’re in good hands with our team of legal experts, healthcare professionals, revenue specialists, and technology experts.
Our E360 RCM™ platform interfaces directly and securely with your EHR/HRIS system.
With seamless integration and service, all you’ll see is the boost to your bottom line.
