RP Sanjiv Goenka Group

Hospital expands coverage, improves patient satisfaction and strengthens cash flow

The challenge: Securing coverage for Medicaid patients

Our client, a large acute-care hospital on California’s central coast, faced continuing challenges in identifying & enrolling qualified patients into Medi-Cal, the state’s Medicaid program. This issue spawned additional problems: low patient satisfaction, a high volume of self-pay patients, and a poor payment recovery rate. Although the hospital was working with an eligibility vendor, that vendor consistently—and often erroneously–reported many referrals as ineligible for Medi-Cal coverage. As a result, patients were facing increased financial burden, stress and dissatisfaction, sometimes even forgoing treatment & care.

The solution: High touch eligibility & enrollment services backed up with digital outreach

The hospital initially tapped Firstsource eligibility services to follow up with post-discharge patients that its existing eligibility vendor could not contact because it had only limited voice calling capacity, and no text or email options. Within the first month, our eligibility team found 53 patients who had been erroneously tagged as self-pay.  We used our multi-channel outreach approach, including emails and texts, to reach post-discharge patients and help them gain Medi-Cal coverage. Our extremely easy to use application enabled patients to upload images of required documents right from their smartphones. We submitted and followed up on these applications.

Our success rate was such that the hospital then split its eligibility volume between Firstsource and the incumbent vendor. Within four months of that division, as the incumbent vendor reduced its resources, the hospital asked Firstsource to take over 100% of the hospital’s Medicaid eligibility and enrolment process.

The transition from the original vendor was abrupt but we launched full-service outreach within a day. To ensure our client’s eligibility processes were not interrupted, our operations team members travelled 70 miles each day for two weeks to take over in-hospital patient screening.

Upholding our client’s branding and values

While our interim operations team covered in-hospital outreach, we established a dedicated team of professionals to provide eligibility services in line with the hospital’s values and brand. Our team had to be responsive and accountable, acting as empathetic patient advocates.

We increased onsite coverage to 24/7 from the previous vendor’s five days a week. Our team acts as an extension of the hospital’s staff. They often work with emergency department patients; after these patients are stabilized, outreach team members meet with them to determine their Medi-Cal eligibility and begin the application process before the patient leaves the hospital. We also act as authorized agents for patients, so we manage the appeals process if patients are initially denied Medi-Cal coverage.

Our team uses a multichannel digital approach to reach patients after discharge when necessary. The channels include a digital portal, text messages and email, all of which are labelled with the hospital’s branding. We share the analytics on these outreach efforts with our client, giving it invaluable insight into the most effective days, times and engagement styles to reach its patients.

The results: Satisfied patients, strengthened brand, stronger financials

With Firstsource Eligibility & Enrollment Services, our client has been able to improve patient satisfaction with timely access to Medi-Cal benefits and healthcare services. The hospital’s adoption of our multichannel outreach has elevated their visibility throughout the community while simultaneously ensuring improved health outcomes for their patients.

Our ability to convert patients from self-pay to Medi-Cal has also increased the hospital’s financial strength. In less than four months, we achieved Medi-Cal coverage for 500+ patient accounts, uncovering more than $400,000 in additional charges our client could submit for payment. In just six months, we improved cash collections by 2X.

In one instance, we resolved a case in which an uninsured patient, hospitalized for a year and counting, was accruing a $1.9M bill. Our team assessed the situation and worked with the state to secure coverage and ease the financial burden for both hospital and patient.

Our continuing success with Medi-Cal eligibility led the hospital to award Firstsource its Medicaid Redetermination business. That work in part included ensuring we did not duplicate outreach to patients with accounts at both our client and its sister hospital. We managed outreach to 18,000 patients for 90 days.  At the end of the 90 days, 15,000 showed having Medi-Cal coverage.

Business impact

Improved patient access to services and insurance benefits

< 4 months

Gained Medi-Cal coverage for 500+ patient accounts

> $400,000

Uncovered in additional Medi-Cal eligible charges


Increased cash collections in just six months


Resolved ongoing patient case

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