Eligibility Services

Adreima specializes in assisting uninsured patients with their application and enrollment in Medicaid, and other Government programs. On-site team members screen self-pay patients to determine eligibility and assist those patients in completing the application at time of service. We continue to work with patients after they are discharged to ensure that their eligibility, notifications and authorizations are completed in a timely manner. All of our services can be conducted in Spanish or English to serve the needs of this diverse population.

In addition to the benefit to the hospital of increasing enrollment, this is also an essential service for many communities that have a high incidence of patients without insurance. By increasing the number of patients within a community that are taking advantage of these programs, the public perception of the hospital is enhanced.

With a focus on increasing the conversion rate of patients accepted into these assistance programs, we provide comprehensive follow-up to facilitate enrollment after discharge, including:

• Extensive phone and letter follow-up to collect documents
• Home visits, conducted per established protocol
• Taxi service to help patients attend interviews
• Courier service to quickly transport documents
• Licensed private investigative services to locate patients as needed

We also provide ongoing tracking of patients, and reporting on our enrollments, to provide the hospital with a solid understanding of the conversion rates, as well as the reasons that a patient is not eligible (when applicable). Our proprietary system can also track actual payments for services rendered to patients enrolled by Adreima, to provide a cost benefit analysis of these enrollments. In the event a qualified patient is denied eligibility unjustly, our Extended Services Specialists can coordinate the appeals process.

By pairing our Eligibility Services with the other Adreima revenue cycle management products, the hospital is able to enjoy greater returns on their overall Medicaid program.

*HFMA staff and volunteers determined that this product has met specific criteria developed under the HFMA Peer Review Process. HFMA does not endorse or guarantee the use of this product.