GOVERNMENT/THIRD-PARTY ELIGIBILITY, COVERAGE & INSURANCE RECOVERY SERVICES
Comprehensive Recovery Services
Health Advocates understands that rigid and automated workflows are typically designed to efficiently move volumes of accounts along a defined path and protocols. While “conveyer-belt” processing is effective for the majority of cases, automation and static processes often lack a timely pause on problematic cases to sufficiently evaluate and resolve the root causes impeding coverage and/or payment.
Our expertise lies in our ability to carefully screen individuals, evaluate cases, and identify and apply the appropriate resources to resolve Self-Pay accounts and Self-Pay Balances after Insurance. Our ability to identify all options for coverage and payment results in the highest compensation to clients and maximum benefits to the individual or applicant.
Eligibility and Enrollment Services
Health Advocates provides hospital-based or post-discharge Eligibility and Enrollment services and staff to assist clients reduce the number of unsponsored and underfunded patients. We tailor our support to each client’s unique needs – most often to supplement a client’s own resources on complex cases where focused attention or expertise is required to overcome an Eligibility denial, to reinstate commercial coverage, or to upgrade existing coverage that might otherwise be limited as to benefit scope or duration. Health Advocates has several services to ensure that all opportunities to reduce bad debt and charity care write-offs have been identified. Eligibility solutions also include those focused on increasing reimbursement via Medicare Disproportionate Share and other government funding and cost offset sources.
Social Security Advocacy Services
Health Advocates represents claimants at all stages of the application process for Social Security Administration (SSA) disability benefits including initial applications, re-considerations, and all appeal/hearing levels. Case Managers, Legal Assistants, and Attorneys complete all forms, file appeals with SSA, gather medical records and other evidence and represent individuals at hearings to greatly improve the odds of being approved for Supplemental Security Income (SSI) and/or Social Security Disability Insurance (SSDI) benefits. Many claimants receive both SSI and SSDI benefits resulting in Medicaid/Medi-Cal and Medicare (Medi-Medi) coverage which also serves to increase reimbursement to hospital and health plan clients.
We are uniquely experienced with serving and engaging the homeless and underserved populations as this demographic is a significant proportion of referrals for all our entitlement services.
Insurance Collection and Recovery Services
Unpaid Commercial and Government Insurance claims result from complexities of a Managed Care (MC) contracted and non-contracted environment. Most claim denials can be resolved by the client but others require outside expertise and focused attention. Insurance service expertise overlaps and enhances Traditional Eligibility services by reducing Self-Pay debt in the following scenarios (a) some denials can be resolved by retroactively reinstating insurance coverage, (b) by identifying Self-Pay balances that are partially or fully the responsibility of a health plan or other third-party, (c) by concurrently pursuing an “initial” insurance denial and Medi-Cal as “safety-net” coverage where overturning the denial is questionable, and (d) for resolving coverage and reimbursement coordination when both the state (Traditional Medi-Cal) and a MC Medi-Cal plan have shared responsibility on an admission.
Insurance Services also include expertise in the timely identification and recovery from Workers’ Compensation, Third-Party Liability, and other responsible sources.