Eligibility Determination For Hospitals

Comprehensive Customized Solutions

Improving your revenue cycle means eliminating the potential for bad debt. The best way to do that is to provide beginning-to-end assistance with eligibility determination for your patients and their families. With ClaimAid, you have a partner dedicated and focused on helping your hospital increase the number of eligible patients who qualify for Medicaid, Supplemental Security Income (SSI) or other health coverage programs, such as the Health Insurance Marketplace.

Our experienced, compassionate patient advocates know the health care reform rules and regulations and are specifically trained to help determine eligibility quickly and accurately. We meet patients wherever it takes—whether it’s in their hospital room or in their homes. These seasoned advocates know the right questions to ask to get the critical and relevant information in dealing with the complexities of Medicaid and state-specific programs like the Health Indiana Plan (HIP).

With ClaimAid, you have a partner dedicated and focused on helping your hospital find opportunities and comprehensive customized solutions for all your health care management needs.  We offer the ClaimAid Advantage.

Your hospital will notice the benefits from…

  • reduced bad debt and increased cash flow from an improved bottom line.
  • timely reimbursements and increased revenue for your hospital.
  • tight collaboration with a compassionate, expert partner on health care reform compliance and policies.
  • reduced workload and more time to focus on what’s important to you—the best patient care possible.
  • experienced representation in your provider prior authorization appeals.
  • sustained results through a personal relationship.

Your patients will have peace of mind as we…

  • provide health care coverage options and offer assistance in obtaining all required documentation and technical support.
  • take patients and families by the hand and navigate them through the screening, application and enrollment process.
  • assist with filling re-applications for patients whose eligibility has lapsed and offer your patients representation with eligibility adverse actions.
  • handle all the details with the utmost care from the very start.
  • maintain objectivity and focus on your patients and their families.
Eligibility Determination For Individuals and Families

Navigating Through a Complex World

The last thing you need when you or someone you love is fighting a serious illness or facing ongoing medical treatment is the added stress from overwhelming paperwork and uncertainty surrounding medical eligibility. With the new health care reforms, this process can be even more confusing. At ClaimAid, we offer the expert assistance that can provide peace of mind and a clear path toward eligibility.

Our experienced, compassionate patient advocates can walk you and your family through the often complex process form the very start and make sure everything is prepared accurately and completely.  We offer the ClaimAid Advantage.

You will have peace of mind as we…

  • meet you wherever you are, whether it’s in your hospital room or at home, to navigate you through the screening and enrollment process step-by-step.
  • communicate with your hospital or clinic so they understand your effort to pay.
  • provide on-going advocacy, support and representation if we believe an application is denied incorrectly or if there is an appeals process.
  • handle all the details with the utmost care from the very start.
  • maintain objectivity and focus on you and your family, which is what matters most.

Let us handle all the details with the utmost care from the very start.
Contact us today for the personal support and guidance that can help you start receiving the benefits for which you might be eligible.

Screening and Enrollment

There are patients who do not feel they can qualify for health coverage.  Often times individuals and their families are facing difficult decisions or life-threatening issues.  Financially, this process can be an intimidating ordeal, maybe even hopeless.  We offer beginning-to-end assistance with real-life solutions. We quickly and directly connect with patients and their families by taking each case personally, creating solutions that benefit everyone involved. Our experienced, compassionate patient advocates ensure that every screening and application is handled with the utmost care from the very start.

We maintain objectivity and focus on walking each patient or individual and their families through the complicated process step-by-step.  Most importantly, we offer everything from screening for potential eligibility of all health care coverage, including Medicaid, Supplemental Security Income (SSI) or other health care coverage programs, such as the Health Insurance Marketplace to assisting with filling re-applications for patients when eligibility has lapsed.

Medicaid

Medicaid eligibility is determined by several factors and can be complicated, but we can help. There are many categories of eligibility and several different Medicaid programs to consider, including the possibility of Medicaid Expansion in the state of Indiana.  The screening and application process can seem overwhelming and intimidating.  Often patients and their families feel they do not even qualify for any health coverage, including Medicaid.

In such a complicated environment, we can help navigate the patients through the eligibility process and offer assistance in getting all the proper documentation with the utmost care.  At the same time, help hospitals and providers increase the number of eligible patients and individuals who qualify for programs, such as Medicaid.

Our expert, compassionate patient advocates will work one-on-one with patients when screening and applying for health coverage eligibility, including Medicaid.  At the same time, we will work with hospitals and providers in making sure we find ways to minimize their costs, maximize their return on investment and help build better relationships with their patients.

Social Security Benefits

Understanding Supplemental Security Income (SSI) and Social Security Disability (SSD)

Both SSI and SSD can be confusing. Although the Social Security Administration (SSA) administers both, SSI and SSD are very different.

Supplemental Security Income (SSI)

SSI is a program that provides a monthly benefit to an adult or child who meets citizenship status and is disabled, blind or aged (65 years or older) with limited income and resources. This benefit is not based on the earnings record of an individual, unlike retirement Social Security and SSD. It is based on need to help with food, clothing and shelter. It is a requirement when applying for Medicaid to also apply for any potential benefit that one may be entitled. This includes applying for Social Security benefits. Persons who have worked enough quarters to receive SSD or Social Security Retirement whose monthly benefit is less than the Maximum Federal Supplemental Security Income (SSI) payment may also receive SSI to bring their payment up to the maximum (Federal max.  1/1/17: $735 per person, $1103 couple).

Social Security Disability (SSD)

SSD is a program that pays benefits to an adult who meets citizenship status who is disabled or blind who must have worked long enough to have paid Social Security taxes to have become insured for benefits. The monthly benefit amount is based on the Social Security earnings record of the insured worker. Twenty-four (24) months following the entitlement date of Social Security Disability benefits, the individual is eligible to enroll and receive Medicare coverage.

SSI and Spousal Impoverishment Standards

Our expert, compassionate patient advocates can assist patients and their families from the very first encounter, screening for potential eligibility, filing applications and following up through the application resolution for Medicaid, SSI and SSD benefits. Contact us today to see how we can help navigate you through the eligibility process.

Health Care Providers

Social Security SSDI and SSI Disability

Filling in the Federal Ga

At ClaimAid, we understand how overwhelming it can be for patients and their families when applying for disability benefits. It’s a time-consuming and frustrating process, and it’s overwhelming to even make one more phone call.  That’s why ClaimAid has expanded its services by now offering assistance in applying and appealing for federal Social Security Disability benefits. This invaluable service is in addition to the long-standing eligibility support that we have been providing at the state level for 24 years.

Along with this service, we are excited that Tammy Loy, JD, serves as our Social Security Disability Advocate to help fill the gap in reviewing claims for federal benefits as well. Tammy is a reflection of what ClaimAid stands for and why we added this valuable service. Having experienced her own family members feeling lost in the medical system, she understands and can empathize with patients. Having been there both on the personal and professional side, she will focus on Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) representation with the same dedication, integrity and expertise you have come to expect from ClaimAid as your trusted partner and compassionate advocate.

Advocacy and Guidance

At ClaimAid, we offer compassionate assistance when guiding patients through the application and appeals process for disability benefits. We are dedicated to finding all potential legal challenges, as well as taking a comprehensive look at all practical solutions in order to determine the patient’s best course of action at each stage of the process-including the federal level. Simply put, we will be there for patients and their families every step of the way, from beginning to end.

Below are just some of the ways ClaimAid can help our patients and their families:

  • File application and all forms necessary for reconsideration and hearing.
  • Prepare and file all necessary documentation required during any type of appeal, including medical documents, diagnosis and laboratory results.
  • Review Social Security file thoroughly to discover possible weaknesses and determine what more is needed to obtain a favorable decision in their case.
  • Be their advocate in all hearings and proceedings, including appearances before an Administrative Law Judge (ALJ), the Appeals Council or the Federal District Court where appropriate.
  • Keep them informed so they know what to expect and will be prepared.
  • Remind them of all doctor appointments with Social Security and/or hearings with Administrative Law Judges.

Ready To Guide With Compassion and Experience

To make it easy for patients and their families, ClaimAid meets them where they are by accommodating their schedule, offering flexible meeting times in their home or at the hospital. We ensure that every patient is treated with compassion and all applications are managed with the highest level of ethical standards and professional care. Whether patients are applying for state, Medicaid or Social Security benefits, we will be there to navigate them through the eligibility and appeals process. Contact us today to learn how ClaimAid’s services can help you today.

Patients & Families

Social Security SSDI and SSI Disability

Filling in the Federal Ga

At ClaimAid, we understand how overwhelming it can be for patients and their families when applying for disability benefits. It’s a time-consuming and frustrating process, and it’s overwhelming to even make one more phone call.  That’s why ClaimAid has expanded its services by now offering assistance in applying and appealing for federal Social Security Disability benefits. This invaluable service is in addition to the long-standing eligibility support that we have been providing at the state level for 24 years.

Along with this service, we are excited that Tammy Loy, JD, serves as our Social Security Disability Advocate to help fill the gap in reviewing claims for federal benefits as well. Tammy is a reflection of what ClaimAid stands for and why we added this valuable service. Having experienced her own family members feeling lost in the medical system, she understands and can empathize with patients. Having been there both on the personal and professional side, she will focus on Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) representation with the same dedication, integrity and expertise you have come to expect from ClaimAid as your trusted partner and compassionate advocate.

Advocacy and Guidance

At ClaimAid, we offer compassionate assistance when guiding patients through the application and appeals process for disability benefits. We are dedicated to finding all potential legal challenges, as well as taking a comprehensive look at all practical solutions in order to determine the patient’s best course of action at each stage of the process-including the federal level. Simply put, we will be there for patients and their families every step of the way, from beginning to end.

Below are just some of the ways ClaimAid can help our patients and their families:

  • File application and all forms necessary for reconsideration and hearing.
  • Prepare and file all necessary documentation required during any type of appeal, including medical documents, diagnosis and laboratory results.
  • Review Social Security file thoroughly to discover possible weaknesses and determine what more is needed to obtain a favorable decision in their case.
  • Be their advocate in all hearings and proceedings, including appearances before an Administrative Law Judge (ALJ), the Appeals Council or the Federal District Court where appropriate.
  • Keep them informed so they know what to expect and will be prepared.
  • Remind them of all doctor appointments with Social Security and/or hearings with Administrative Law Judges.

Ready To Guide With Compassion and Experience

To make it easy for patients and their families, ClaimAid meets them where they are by accommodating their schedule, offering flexible meeting times in their home or at the hospital. We ensure that every patient is treated with compassion and all applications are managed with the highest level of ethical standards and professional care. Whether patients are applying for state, Medicaid or Social Security benefits, we will be there to navigate them through the eligibility and appeals process. Contact us today to learn how ClaimAid’s services can help you today.

Health Insurance Marketplace
The world of health care is changing.  Much clarity is still needed in regards to the laws and regulations coming with the Affordable Care Act (ACA).  Whatever impact to you as hospitals, providers or patients—our dedicated and experienced staff has the resources and expertise to stay on top of what this transformation in health care reform specifically means for you.  More importantly, our compassionate patient advocates can navigate uninsured and underinsured patients through the health care coverage options with beginning-to-end assistance.
Healthy Indiana Plan (HIP)

The Healthy Indiana Plan (HIP): 

The Healthy Indiana Plan (HIP) is a health insurance program offered by the state of Indiana.  The plan covers Indiana residents ages 19-64 who meet specific income guidelines.  In 2015, the state introduced HIP 2.0 which added several benefit options such as dental, vision, and pregnancy coverage.  HIP coverage also includes hospital services, mental health care, physician services, prescriptions, diagnostic exams and disease management.   Some individuals are still required to contribute a small portion to their POWER Account, and this amount is calculated based off of household size and income.

How can ClaimAid help?

Our highly trained, compassionate Patient Advocates can offer individuals and their families’ assistance in finding the best health coverage options available.  Our advocates will screen patients for eligibility and guide them through the enrollment process.  We provide support in clarifying complex notices and submitting necessary documentation to ensure deadlines are not missed and coverage is secured.  Our focus is on the person; making sure they get and keep the coverage they need.

Presumptive Eligibility (PE)

Accuracy is key when completing PE applications – We can help.

Presumptive Eligibility is a category of assistance offered through The Indiana Health Coverage Programs (IHCP) by which individuals can be determined presumptively eligible and receive temporary health coverage until the FSSA determines official eligibility.

Qualified Providers are allowed to assist individuals in completing the online application at their facility and may designate entities to complete the process on their behalf.  The application is available 24 hours a day through Web InterChange and requires answers to questions regarding demographics, family size, and income.

Providers receive real-time presumptive eligibility determinations and if approved, the individual receives immediate, temporary coverage, reimbursed on a fee-for-service or managed care basis.  Individuals are then required to complete a full Indiana Application for Health Coverage in order to keep the coverage.

Providers must enroll and notify the FSSA of their intent to receive presumptive eligibility determinations and will be monitored to ensure that specific performance standards, set by the FSSA, are met.

ClaimAid Patient Advocates are certified Indiana Navigators trained to screen patients for eligibility and complete both the PE and full application for health coverage if appropriate.

Groups eligible for PE coverage include:

  • Low-income infants and children
  • Low-income adults
  • Former foster care children
  • Low-income pregnant women
  • Individuals seeking family planning services only
  • Inmates
Disproportionate Share Hospital (DSH)

Understanding the Disproportionate Share Hospital (DSH) Program

The Disproportionate Share Hospital (DSH) program provides adjustment payments to help hospitals that serve a significantly greater share of low-income patients.  Specifically, individual states receive an annual DSH allotment to cover the costs of DSH hospitals that provide care to low-income self-pay patients not covered by Medicaid, Medicare or other health insurance programs.

Medicare Learning Center – Disproportionate Share Hospital

HRSA – Eligibility & Registration

Medicaid CHIP Program Information

What is the benefit to you?

DSH payments provide financial help which can help you to improve and expand services even with the Affordable Care Act (ACA) reforms.  You are also serving more vulnerable individuals and providing a wonderful community outreach.

How can ClaimAid Help?

Our expert, compassionate patient advocates can assist your patients from the very first encounter, screening for potential eligibility, filing applications and following up through the application resolution for eligibility benefits.

340B Pricing Program

The 340B Drug Pricing Program enables Medicaid participating hospitals to purchase qualified outpatient drugs at discounted prices.

What are the benefits to you?

  • Qualifying for the 340B Program meets the needs of your low-income, uninsured and underinsured patients while stretching tax dollars.
  • This can add up to significant savings for you to improve and expand services even with the Affordable Care Act (ACA) reforms.
  • You will be better equipped to treat individuals who receive coverage established through health care reforms.
  • You are also serving more vulnerable individuals and providing a wonderful community service.

How can you participate?  How can we help?

  • Eligible organizations must qualify and be enrolled with the 340B Program.
  • Registration periods are open four times throughout the year and are processed in quarterly cycles.
  • ClaimAid can help you with the program requirements.  Once enrolled, we can help you maintain your 340B status.
COBRA

What You Need To Know About COBRA.

What is COBRA (Consolidated Omnibus Budget Reconciliation Act)?  Cobra gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as job loss, transition between jobs, death, divorce and other life events.  Qualified individuals may be required to pay the entire premium for coverage.

How does it work?  Is it expensive?  Should you sign up? Is COBRA an option for you? At ClaimAid, our compassionate patient advocates can help you uncover the facts you need in order to answer these questions and more.