How one uncompensated encounter becomes a paid claim.
An uncompensated encounter can become eligible for Medicaid Reimbursement months from now. Here's how RetroCAID catches it before timely filing runs out.
Follow a single encounter through the engine. RetroCAID reviews it every day for up to 365 days — and the moment its Benefit Profile changes in a way that makes it reimbursable, that change is validated at the claim level and delivered to your billing team as an actionable Patient Benefit Alert.
Every uncompensated encounter and patient balance. Not just Self-Pay!
These are examples of benefit changes that can occur long after your standard revenue cycle process has run its course. These changes can take place at any time within timely filing and can affect any uncompensated encounter or balance, often creating new reimbursement opportunities from claims once considered unrecoverable.
RetroCAID monitors the benefit profile of every patient within your entire population of uncompensated claims and balances, reviewing each profile daily for up to 365 days, or until timely filing expires.
One autonomous engine, working quietly alongside your revenue cycle.
RetroCAID passively runs in the background without any integration required. It does three things, continuously, for every uncompensated encounter and patient balance in your system.
Everyone else confirms coverage. RetroCAID recovers revenue.
The two approaches sound similar, but they answer different questions — and capture very different revenue.
Beyond simple detection.Profile changes are validated at the claim level.
Every captured change is evaluated using deterministic claim-level logic to identify whether it creates a new reimbursement opportunity for a previously non-reimbursable encounter. This eliminates false positives and prevents non-reimbursable encounters from moving downstream.
An eligibility response returns a status. A Patient Benefit Alert returns action-ready intelligence — exactly what changed, the payer and coverage detail, and confirmation that the timely filing window is still open.
RetroCAID, answered.
What is a Medicaid Benefit Profile?
The Benefit Profile is a collection of eligibility information, plan coverage descriptions, specific notes, primary, secondary, tertiary and TPL payers, and other information that collectively determine whether and how a patient encounter may be reimbursed. Because any element of the patient’s Medicaid coverage can change after the date of service, a patient's benefit profile is often dynamic rather than static.
Doesn't our eligibility check already catch this?
No — and RetroCAID doesn't replace it. An eligibility check provides patient level eligibility on the day you run it. It can't tell you that an uncompensated encounter from eight months ago just became reimbursable due to a small change within the patients Benefit Profile. Even when billing teams re-check eligibility periodically, the qualifying change often lands in the gap between checks.
What does RetroCAID monitor?
RetroCAID monitors the Benefit Profile of every Patient that has an uncompensated encounter and outstanding balance within in your system — self-pay, sliding fee, uninsured balances, denied claims, unresolved patient balances, and written-off bad debt — for up to 365 days, or until their encounters expire due to timely filing.
Why can't our billing team just do this manually?
Re-checking and validating thousands of historical uncompensated encounters every day is operationally and financially impractical. It isn't a diligence problem — it's arithmetic. RetroCAID performs eligibility and claim-level analysis at volumes no billing team can reach on their own.
Does RetroCAID require EHR integration?
No. There is no software to install or integration required. Implementation is completed by phone in less than 60 minutes, and your first set of results are captured within 48 hours. RetroCAID was designed to operate autonomously alongside your existing revenue cycle workflows, working passively in the background without disruption to your staff, systems, or processes.
What does it cost?
RetroCAID is 100% contingency-based. You pay nothing unless it captures reimbursable encounters — and only after your facility is actually reimbursed by the payer. The agreement is month-to-month and can be cancelled at any time with a simple email.
See what RetroCAID can recover for your facility.
It starts with a straightforward conversation about the encounters sitting in your system right now — no obligation, and no commitment to continue.
// No long-winded sales pitches or PowerPoint presentations.
