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MedData’s patient-focused healthcare eligibility services find appropriate assistance to help pay medical bills, and in fewer days than other providers. Every step of our process is designed to meet the needs of hospitals working to manage their revenue cycles while maintaining the service levels their patients expect.

Other single service line vendors don’t have the technology, expertise, or coordination to process claims in a timely and compliant manner, causing hospitals to miss additional revenue opportunities. But we help solve every challenge throughout the entire patient financial experience, simultaneously screening multiple programs across our unified services.

Over the past 20 years, we have built a better approach through an integrated model that works for hospitals and patients across the various eligibility programs such as:

Medicaid

  • Enrollment Assistance
  • In-State & Out-of-State
  • Long-Term Care Assistance
  • OB Pre-Registration Program
  • Medicaid Secondary

Disability

  • SSI Applications
  • SSDI Applications
  • Representation at Hearing Level
  • Appeals Council Support

Other Programs

  • Qualified Health Plan Enrollment
  • State and County Programs
  • COBRA Assistance
  • Victims of Crime Services
  • Indian Health Services

MedData At A Glance

  • Over $4.2 million billed annually
  • 68,850 Gross OOS Medicaid Placements
  • 20+ years of experience
  • 24/7 patient and client service
  • Service to all 50 states and Puerto Rico
  • 95% client retention rate
  • 97% patient satisfaction rate

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

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Institutionalized Expertise

We have been providing this service to our customers for over 20 years. Our teams of billing experts have access to tools that allow them to quickly identify and verify coverage, including our Payer Management Portal, which tracks all Medicaid payers nationwide and drives workflows and quality assurance based on those profiles.

Extensive and Continuing Technological Development

We have internal tools and processes that identify what referral and certification requirements are required for all out-of-state Medicaid plans. Some of these tools that set us apart are:

  • Claim Editor/Electronic Submission
    • MedData’s proprietary billing tool, the Claim Editor, identifies payer-specific billing rules and guidelines for out-of-state Medicaid plans.
  • Eligibility Verification Website
    • Hospital registration staff has access to an Eligibility Verification tool that uses patient demographic information to check against state databases for patient eligibility for Medicaid, Medicare and other third-party payers and automatically uploads the account information into our account management system where it is immediately flagged to an eligibility screener for double-checking.
  • Screening/Tracking Tools
    • Our screening technology allows our staff to screen for all 350 different government programs across the country. It’s updated in real-time as federal and state policies change, so advocates are equipped with up-to-date information to accurately validate the patient’s coverage.

Key Differentiators

Our proprietary system scans hundreds of federal, state, county, and community programs. Nobody else is even close.
We rescreen in real time until a final diagnosis is reached.
Our on-site advocates are trained on our philosophy of “the patient at the forefront of everything we do,” and they bring this to every encounter.
You will see the results quickly, and our reporting system empowers you to address trends while giving you peace of mind that choosing MedData was the right decision.
Simultaneous screening for these programs means that even if/when an eligibility case has fallen through, we identify another payer source.
With this program in place, we scan multiple state and commercial databases for potential coverages on all self-pay patients and any TPL case that doesn’t have a secondary payer identified.

An Integrated Service Line Approach

Our Eligibility and Disability services are an integral part of MedData OneTouch℠ – an integrated service line approach that specifically improves upon siloed services  and unites them into a single solution. This platform does something entirely unique in the marketplace by identifying all payer sources and the most appropriate coverage in the properly compliant order through a single touch-point for patients, whether they’re insured, under-insured, or uninsured.

Legislative Monitoring and Involvement

MedData has a dedicated team who proactively represent our customers in legislatures at the state and national levels. They are dedicated to researching federal and state laws and training our employees on program or policy changes. This team is led by Doug Turek, our Senior VP of Regulatory Government Affairs.

Innovation

MedData’s MPower Audit Capability audits the work of our advocates in real-time using proven rule sets that guide them through the steps necessary for each account, so revenue recovery is maximized and compliance is maintained. This practice maximizes revenue and complies with CMS Payer of Last Resort Regulations.

Our Process

We begin by screening patient demographic information against state databases to ensure they’re eligible with an Out- of-State Medicaid payer for the date of service before the reimbursement claim is submitted.

The authorization experts work with the EV and documentation processing teams to make sure claims are processed correctly with payers as quickly as possible.

Our documentation processing team organizes all accounts waiting for documentation from our client hospitals. Usually, they correspond with hospital staff directly and will develop a system of communication and document retrieval between our clients and us that’s as least disruptive as possible.

Enrollment representatives help our clients with the complicated task of obtaining the proper provider enrollment for any and all states. They ensure that, wherever possible, our client hospitals will have access to payer web portals (to check claim status and to pull remittance advices), eligibility software (to verify eligibility), and electronic submission software (to submit claims electronically) once they are enrolled with a Medicaid payer as a provider.

Then, our billing representatives check claims against our billing manuals to make sure claims are submitted according to a payer’s guidelines the first time they go out.

Every time an account is worked, a follow up date is assigned to ensure accounts are worked timely. Once an account is billed or appealed, follow up with the payer occurs every 30 calendar days to ensure claims are processed correctly. If the claim is denied, the validity of the denial is reviewed. auditor. If an appeal is warranted, all required documentation will be obtained and the appeal will be submitted based on the payer’s guidelines. Once the account pays, the claim is reviewed to ensure the account paid correctly.

MedData has developed one of the most robust and effective sets of account management reports in the industry. Every month, we’ll provide you with an executive summary to analyze the number of accounts placed, liens filed, accounts billed, aged trial balance (by account and by balance), conversion rates, and it highlights high dollar collections and high dollar accounts in process.

Case Studies

As a leader in the revenue cycle management industry, we strive to help your increase payments and produce results. Download the case studies below to see how MedData’s services have improved the revenue cycle of hospitals and clinics:

Cut costs.
Repair your bottom line.
Discover new revenue streams.
You deserve more from your revenue cycle.

Learn how you can create a better experience for your patients
and boost your bottom line.