Real-Time Eligibility.
Real-Time Enrollment.
You're Treating Insured Patients. You Just Don't Know It Yet.
- AI screening. eIdentify coverage opportunities in real-time across Medicaid, commercial insurance, disability programs, and financial assistance
- Expert counselors. Navigate complex state requirements with direct SSA andMedicaid agency access across all 50 states
- Digital enrollment tools. Anytime, anywhere 24/7 access enables >90% of patients to complete self-screening, with 40% engaging on the first text
Results that scale across every engagement
99%
gross approval rate
$7.75B
approved funding
>93%
completion rate
>60%
documents signed within 1 hour
AI-Powered Eligibility & Enrollment Across Five Critical Areas
Simplify Enrollment and Prevent Coverage Gaps
Insurance Discovery & Verification: Explore every coverage option. Algorithms identify eligibility across all programs—Medicaid, commercial, workers' compensation, specialty coverage. State specialists verify Medicaid coverage in all 50 states.
Medicaid Enrollment & Redetermination Support: Certified application counselors navigate complex state-specific requirements. Center's extended hours prevent coverage gaps during redetermination.
Disability Program Navigation: Our representatives are SSA's Appointed Representative Services, providing real-time document management and case tracking. Our medical review teamprepares comprehensive briefs to facilitate faster claim determinations.
Maximize Claims Approval and Reimbursement Speed
Claims Optimization & Approval Acceleration: Maximize reimbursement through expert navigation of complex program requirements and direct agency relationships. Ensure applications are complete, accurate, and submitted with all required documentation.
Denial Prevention & Recovery: Prevent denials with predictive analytics and process mining. When denials occur, our specialized teams manage the full appeals process from initial reconsideration through administrative law judge hearings.
Payment Acceleration: Reduce days in accounts receivable through streamlined workflows, automated eligibility verification, and real-time status tracking.
Maximize Financial Recovery and Minimize Patient Burden
Bad Debt Reduction: Convert self-pay accounts to covered status before they age into bad debt through real-time screening at point-of-care.
Uncompensated Care Reduction: Reduce charity care and uninsured discounts through comprehensive screening that identifies every possible funding source, from government programs, through commercial insurance, specialty programs, and community assistance.
Financial Assistance Optimization: Simplify and accelerate the financial assistance process with digitized screening that identifies qualification patterns across federal, state, and local assistance programs.
Pharmacy Assistance Programs: Reduce patient out-of-pocket costs and improve medication adherence. Identify patients eligible for prescription assistance programs, coordinate enrollment, and ensure ongoing support.
AI-Powered Automation Handles Routine Processing Tasks
Digital Patient Intake & Self-Service: Mobile-optimized tools thatwork 24/7. Our branded microsite enables patients to complete financial screening, upload documents, and track application status from any device.
Automated Workflows & Intelligent Processing: AI powers routine tasks while flagging complex cases for expert review. Our Patient Advocate Copilot provides real-time guidance to staff.
Digital Document Submission & E-Signature: DocuSign integration, mobile document capture, and secure patient portals enable 24/7 document submission with real-time status updates.
System Integrations &Data Exchange: Seamlessly integrate with your existing technology stack through APIs, EDI file transfers, and custom interfaces.
Transform Data Into Actionable Business Insights
Performance Dashboards & Real-Time Monitoring: Daily dashboards provide visibility into screening rates, conversion rates, approval rates, turn around times, and financial impact with drill-down capabilities.
Comprehensive Reporting: Access detailed reports on assignments, approvals, inventory aging, conversion rates, returns, and digital engagement metrics.
Forecasting & PredictiveAnalytics: Anticipate coverage changes, identify emerging trends, and proactively address potential issues before they impact revenue.
Opportunity Analysis & Continuous Improvement: Identify untapped opportunities for additional coverage and revenue recovery through data analysis and benchmarking.
Navigate HR1 With Confidence
We manage the complexity so eligible patients stay covered and you recover revenue.
Move beyond guesswork to a clear, expert-backed action plan.
Leading hospitals identify at-risk patients before coverage lapses, guide them through requirements, and recover revenue on compressed timelines.
Backed by decades of Medicaid expertise and experience, our solution can help you manage the complexities while staying focused on patient care.
