Out-of-State Medicaid Enrollment & Billing Best Practices
Webinar Transcript
Moderator: I want to welcome Jez, Lisa, and David from Elevate Patient Financial Solutions. Today, they'll review general requirements and best practices for out-of-state Medicaid enrollment in Kansas and neighboring states.
With that, I'll turn it over to David to get us started.
Vice President of Business Development David Cartier: Thank you for spending an hour with us today. My name is David Cartier, Vice President of Business Development. I've worked in healthcare revenue cycle for more than 30 years.
I'd like to introduce Jez Garcia, our Regional Vice President of Out-of-State Operations. If you see "OOS," that refers to out-of-state operations.
I'd also like to introduce Lisa Almaraz, our Executive Vice President of Strategy.
We're excited to be here and will spend about 30 minutes walking through today's presentation. We'll leave plenty of time for questions at the end, but please feel free to submit questions in the chat throughout the session.
Today, we'll provide a brief overview of ElevatePFS, discuss out-of-state Medicaid and the major challenges providers face, review provider enrollment and billing requirements, walk through neighboring state requirements, and share tips for managing the process effectively.
A little about ElevatePFS: We've been around for approximately 40 years and have an experienced leadership team. Between Jez, Lisa, and me alone, we bring nearly 80 years of industry experience.
We have approximately 2,700 employees nationwide and support more than 1,700 client sites. We're proud of our client retention rate, our work with HFMA, our Great Place to Work certification, and our recognition as a top performer in the industry.
When I refer to Eligibility and Enrollment, I'm talking about helping self-pay patients obtain coverage, including out-of-state Medicaid patients. Under Complex Claims, we manage out-of-state Medicaid, third-party liability, workers' compensation, veterans' claims, and coordination-of-benefits denials. We also provide a full suite of A/R billing and follow-up services, as well as self-pay early-out solutions.
All of our services are designed to help patients navigate the process and help our partners maximize reimbursement opportunities.
Our Out-of-State Medicaid Billing and Enrollment team manages approximately 60,000 out-of-state Medicaid claims and more than 3,000 provider enrollments annually. We work with every state and payer across the country on a daily basis.
I'll turn it over to Lisa, and then she'll hand it off to Jez.
Executive Vice President of Client Strategy Lisa Almaraz: Thank you, Dave. As many of you know, each state's Medicaid program has its own rules, deadlines, and policies. With more than 450 Medicaid payer profiles, navigating those differences can be challenging.
Unfortunately, many out-of-state claims fall through the cracks, resulting in providers writing off services that could have been reimbursed. The unique enrollment requirements and constant changes leave providers frustrated with the process.
The good news is that with the right strategy, support, and expertise, organizations can successfully navigate these complexities, reduce confusion, and improve reimbursement outcomes.
I want to discuss the importance of a proactive A/R management strategy and how it can help reduce the financial burden associated with out-of-state payers.
It's critical to know filing deadlines for each state and implement a streamlined tracking process to monitor and escalate accounts approaching those deadlines. Doing so helps prevent technical denials that can negatively impact financial performance.
It's also important to reconcile inventory to ensure all charges and claims are captured. Monitoring cumulative charges, high-dollar accounts, and aging inventory provides greater visibility into opportunities for recovery.
One strategy that has helped us monitor performance is reviewing monthly volumes by both state and payer. This allows organizations to analyze historical performance, identify opportunities for improvement, and track denial trends more effectively.
Comprehensive reporting is also critical. Monitoring recovery rates by state and tracking account progression can identify delays and trends that contribute to improved out-of-state reimbursement performance.
I'm going to pass it over to Jez, who will review the operational workflow and processes in greater detail.
Vice President of Out-of-State Operations Jez Garcia: Thank you, Lisa. Good afternoon, everyone. I'm excited to talk with you about out-of-state Medicaid. Before joining ElevatePFS, I spent many years working within a hospital system managing out-of-state Medicaid billing. I'm fortunate to continue working in this area and applying many of the best practices we've developed over the years.
The most important factor for success is having a strong workflow. You need to clearly identify these accounts and determine whether the patient is eligible for Medicaid coverage on the date of service.
Patients sometimes believe they have Medicaid coverage, and sometimes they're unsure. The first step is determining eligibility, understanding available benefits, and confirming whether the payer is truly an out-of-state Medicaid payer. There are commercial plans that can appear similar, so it's important to identify exactly what coverage the patient has and whether there is an HMO involved.
Once you've identified the payer, it's important to understand the requirements for that state. What are the enrollment deadlines? What are the claims deadlines? Is prior authorization required? Do you need provider enrollment before you can initiate authorization?
Understanding those state-specific requirements is essential to managing the process effectively.