Compensating for
Uncompensated Claims
A patient’s Medicaid benefit profile is subject to change at any time. For instance, eligibility may initially be denied, then subsequently approved upon appeal several months later. Delays in final determination can also occur if patients are slow to submit the required documentation.
Even after eligibility has been established, the patient’s benefit profile may continue to evolve. Eligibility might be lost, the scope of benefits could either expand or decrease, and secondary or tertiary payers may be added or removed.
It’s this fluidity that demands so much more than a simple “eligibility check”. It requires constant monitoring of the patient’s benefit profile to ensure these changes are captured and every dollar owed is reimbursed.
Compensating for
Uncompensated Claims
A patient’s Medicaid benefit profile is subject to change at any time. For instance, eligibility may initially be denied, then subsequently approved upon appeal several months later. Delays in final determination can also occur if patients are slow to submit the required documentation.
Even after eligibility has been established, the patient’s benefit profile may continue to evolve. Eligibility might be lost, the scope of benefits could either expand or decrease, and secondary or tertiary payers may be added or removed.
It’s this fluidity that demands so much more than a simple “eligibility check”. It requires constant monitoring of the patient’s benefit profile to ensure these changes are captured and every dollar owed is reimbursed.
Constant Medicaid churn and fluctuating
benefit profiles make it easy for community
health providers to miss critical benefit updates
and reimbursement opportunities!
Providers collect more when they…
Stop “Checking” Medicaid Eligibility and…
Start Monitoring Benefit Profiles!
Retroactive Medicaid Tracking
The Self-Pay Problem
A patient’s benefit profile can change at any time. While a patient may not have had Medicaid coverage on the date of their original encounter, many times that same patient can go on to become a Medicaid recipient long after their initial visit.
This potentially makes their original encounter with your facility, eligible for Retroactive Medicaid reimbursement. Unfortunately, the task of tracking thousands of uncompensated encounters on a daily basis to determine Medicaid eligibility or to capture benefit profile changes are not only cost-prohibitive, its virtually impossible. As a result, many perfectly good retro-billable opportunities will go unnoticed and expire beyond their respective timely filing periods.
Everyday… a Self-Pay encounter within your system becomes eligible for retroactive Medicaid reimbursement!
Everyday… reimbursable Retro-Medicaid encounters expire because they weren’t discovered and billed in time!
Continuous and Autonomous
Retrospective Eligibility Monitoring for
Uncompensated Encounters and Balances
Retrospective Eligibility Monitoring for
Uncompensated Encounters and Balances
The RetroCAID Solution
RetroCAID® continuously and autonomously monitors the benefit profiles of patients with uncompensated encounters and balances across your organization. Each patient and encounter is reviewed daily for up to 365 days, or until it passes timely filing, ensuring no reimbursement opportunity is overlooked.
Built specifically for the complexity of Community Health billing, RetroCAID uses advanced intelligence and deterministic logic to interpret nuanced eligibility and coverage changes in real time. When a benefit profile changes in a way that suddenly makes an encounter and the patient services provided reimbursable, your team is immediately alerted.
Every alert includes the precise details of what changed, along with the essential billing information needed to take action, ensuring your team can confidently capture revenue that would otherwise be missed.
Read MoreThe Uncompensated Care Solution
Acting as a safety net, RetroCAID® passively monitors the benefit profile of every patient that has uncompensated encounters within your system. Every patient/encounter is monitored daily for 365 days or until it expires past timely filing.
If the benefit profile of any encounter changes, making it a reimbursable service, your facility is immediately alerted and provided with the details of the specific change. This includes all the essential billing information required for reimbursement.
The Uncompensated Care Solution
Acting as a safety net, RetroCAID® provides daily tracking of every Self-Pay and Sliding Fee encounter within your system. Each encounter is monitored for the full length of its respective timely filing period. If the eligibility information or benefit profile of any encounter changes, your facility is immediately alerted and provided with the details of the specific change. This includes all the essential billing information required for reimbursement.
No Integration or Remote Access Required • Month-to-Month Agreement • No Software to Install
Fully Implemented by Phone in Less Than 60 Minutes!
100% Contingency Based Service!
Pay nothing unless RetroCAID captures reimbursable encounters and...
more importantly... only after your facility is reimbursed by the payer!
1-888-745-1726
Proudly Serving
5,000 Community Health Facilities
in 49 States, DC and VI!
