Breaking down Barriers to Success in Out-of-State Medicaid Billing
Successful execution and measurable results from Out-of-State Medicaid Billing activity hinge on two related challenges: State Registration and Enrollment, and Regulatory nuances and changes. To receive payments for a state’s Medicaid services, a provider must enroll in the patient’s respective “home” state program and provide an often extensive amount of proprietary and/or confidential data. Further, each state sets its own payment rates for out-of-state providers. Not surprisingly, out-of-state payment rates are typically lower than in-state. Providers can get ahead of the process by working with a trusted partner like Invicta to break through roadblocks and stay abreast of continuous state-by-state changes.
According to Invicta’s Vice President of Revenue Cycle Management, Summer Dobbs, “The administration of Out-of-State Medicaid billing is notoriously complex for healthcare systems and hospital providers. In fact, we know that some providers choose not to participate and simply write off the debt because of the tedious nature of the work and the unique requirements of each state.”
We asked Summer to break down Invicta’s offerings in the simplest terms.
What makes Invicta a great fit for any provider’s Out-of-State Medicaid needs?
Comprehensive Solution
Invicta offers clients the ultimate in trust, flexibility, and customization for Out of State Medicaid Billing. We can handle all Medicaid claims – fee for service and managed care. We will manage all aspects of billing, collection, and provider enrollment. Then, we work the claim from beginning to end or wherever you would like us to fit in your process. We have a dedicated, seasoned revenue cycle management team with decades of experience that can generate robust reporting capabilities such as: dollars by state, account status, and account status code.
Enrollment Prowess
Invicta offers a sophisticated Provider Enrollment service that allows our team to maximize returns in all states where our clients may have Medicaid patient balances. We review and verify current Provider numbers, then input the data into a customized Provider number database. We complete necessary applications for review and approval by the client then submit them to the approved state for approval. We handle all follow-up until the Provider number is approved. From there, we can submit corresponding claims on behalf of our clients. Through this integrated workflow, we can help our clients receive cash reimbursements with greater rates of success and rapidity.
Automation and Clearinghouse
Our Provider automation and customization capabilities include: Provider Number tracking by state; Payer demographics; IP/OP Provider Number; timely filing deadlines; Notes Field for Payer requirements; effective/expiration tracking; automated alert for expiring IDs; active total charge updates; prioritization in workflow; interconnectivity to Invicta’s internal clearinghouse; and electronic billing is available for all Payers with a supplied 837 File.
Real-Time Eligibility Solutions
Invicta’s Out-of-State Medicaid clients reap rewards from our proprietary Eligibility solution. We can complete Real-time Eligibility checks for more than 1,000 payers nationwide including: Medicare; Veterans Administration; all Medicaid and HMOs; and all major commercial and managed care payers. Additionally, we can produce Real-time Claim Status access to over 700 payers nationwide including Medicaid, Medicare, Veterans Administration, HMOs, and all major commercial payers.
Experienced In-House Remote RCM Team
All interactions with the client will be through and by Invicta personnel, and all reporting and performance measurement will come from Invicta to the client. No portion of these services are outsourced to a third-party. Our professional, compassionate, and tenured team leaders understand the complexities of revenue codes, ICD-10 diagnoses, HIPAA, procedure coding guidelines, insurance recovery best practice, and hospital ecosystems. Our team will review current active Out-of-State Medicaid inventory with the client, as well as the status of active Provider numbers for required states, and we will collaboratively build the right completely remote team to align with the volume of work. So regardless of where a Provider facility is located inside the United States, we can help.
Accelerated Implementation Timeline
For Invicta’s Out of State Medicaid clientele, the life cycle for implementation is greatly condensed. As a rule, Invicta can move from start to “go live” within 30-45 days. Our project management team will work through the implementation tasks leading up to our go-live date. With no interruption to current operations, Invicta will ensure all key milestones are met to support the scheduled go-live date so we can begin maximizing reimbursements as quickly as possible.
Final comments on what differentiates Invicta?
“Our tenured leaders are experienced at configuring and refining processes that are flexible, scalable, and can rapidly adapt to an ever-changing healthcare market. One of Invicta’s Guiding Principles is “Collaboration,” and I believe our clients experience our collaborative approach as we foster our relationships with their #1 asset – their people,” said Summer.
If you’d like to bring Invicta’s services and solutions to your organization, contact us at info@invictahs.com for more information.
LEARN MORE
Successful execution and measurable results from Out-of-State Medicaid Billing activity hinge on two related challenges: State Registration and Enrollment, and Regulatory nuances and changes. To receive payments for a state’s Medicaid services, a provider must enroll in the patient’s respective “home” state program and provide an often extensive amount of proprietary and/or confidential data. Further, each state sets its own payment rates for out-of-state providers. Not surprisingly, out-of-state payment rates are typically lower than in-state. Providers can get ahead of the process by working with a trusted partner like Invicta to break through roadblocks and stay abreast of continuous state-by-state changes.
According to Invicta’s Vice President of Revenue Cycle Management, Summer Dobbs, “The administration of Out-of-State Medicaid billing is notoriously complex for healthcare systems and hospital providers. In fact, we know that some providers choose not to participate and simply write off the debt because of the tedious nature of the work and the unique requirements of each state.”
We asked Summer to break down Invicta’s offerings in the simplest terms.
What makes Invicta a great fit for any provider’s Out-of-State Medicaid needs?
Comprehensive Solution
Invicta offers clients the ultimate in trust, flexibility, and customization for Out of State Medicaid Billing. We can handle all Medicaid claims – fee for service and managed care. We will manage all aspects of billing, collection, and provider enrollment. Then, we work the claim from beginning to end or wherever you would like us to fit in your process. We have a dedicated, seasoned revenue cycle management team with decades of experience that can generate robust reporting capabilities such as: dollars by state, account status, and account status code.
Enrollment Prowess
Invicta offers a sophisticated Provider Enrollment service that allows our team to maximize returns in all states where our clients may have Medicaid patient balances. We review and verify current Provider numbers, then input the data into a customized Provider number database. We complete necessary applications for review and approval by the client then submit them to the approved state for approval. We handle all follow-up until the Provider number is approved. From there, we can submit corresponding claims on behalf of our clients. Through this integrated workflow, we can help our clients receive cash reimbursements with greater rates of success and rapidity.
Automation and Clearinghouse
Our Provider automation and customization capabilities include: Provider Number tracking by state; Payer demographics; IP/OP Provider Number; timely filing deadlines; Notes Field for Payer requirements; effective/expiration tracking; automated alert for expiring IDs; active total charge updates; prioritization in workflow; interconnectivity to Invicta’s internal clearinghouse; and electronic billing is available for all Payers with a supplied 837 File.
Real-Time Eligibility Solutions
Invicta’s Out-of-State Medicaid clients reap rewards from our proprietary Eligibility solution. We can complete Real-time Eligibility checks for more than 1,000 payers nationwide including: Medicare; Veterans Administration; all Medicaid and HMOs; and all major commercial and managed care payers. Additionally, we can produce Real-time Claim Status access to over 700 payers nationwide including Medicaid, Medicare, Veterans Administration, HMOs, and all major commercial payers.
Experienced In-House Remote RCM Team
All interactions with the client will be through and by Invicta personnel, and all reporting and performance measurement will come from Invicta to the client. No portion of these services are outsourced to a third-party. Our professional, compassionate, and tenured team leaders understand the complexities of revenue codes, ICD-10 diagnoses, HIPAA, procedure coding guidelines, insurance recovery best practice, and hospital ecosystems. Our team will review current active Out-of-State Medicaid inventory with the client, as well as the status of active Provider numbers for required states, and we will collaboratively build the right completely remote team to align with the volume of work. So regardless of where a Provider facility is located inside the United States, we can help.
Accelerated Implementation Timeline
For Invicta’s Out of State Medicaid clientele, the life cycle for implementation is greatly condensed. As a rule, Invicta can move from start to “go live” within 30-45 days. Our project management team will work through the implementation tasks leading up to our go-live date. With no interruption to current operations, Invicta will ensure all key milestones are met to support the scheduled go-live date so we can begin maximizing reimbursements as quickly as possible.
Final comments on what differentiates Invicta?
“Our tenured leaders are experienced at configuring and refining processes that are flexible, scalable, and can rapidly adapt to an ever-changing healthcare market. One of Invicta’s Guiding Principles is “Collaboration,” and I believe our clients experience our collaborative approach as we foster our relationships with their #1 asset – their people,” said Summer.
If you’d like to bring Invicta’s services and solutions to your organization, contact us at info@invictahs.com for more information.
LEARN MORE