NHI offers a full-service out-of-state Medicaid account management program to hospitals. We are a business partner with the objective of collecting as many out-of-state Medicaid claims as efficiently as possible and looking for all avenues to maximize recovery.
We work with all Medicaid programs throughout the US including District of Columbia and the Virgin Islands. In addition we work with all Medicaid Managed Care Organizations (MCOs).
Our services include:
- Eligibility Verification
Our clients can verify a patient's eligibility via our website 24 hours a day, 7 days a week. Online submissions allow us to obtain the correct amount of information to provide you with the most accurate results. Turnaround time on results during regular business hours is approximately 10-15 minutes.
- Authorization Notification
As part of our eligibility verification service we advise you if an authorization is required. We supply you with the contact information to obtain a timely authorization minimizing the need for post-treatment authorization appeals which we will file on your behalf.
- Claim Submission
Clients can submit claims to NHI in a variety of formats and media including electronic (ANSI, print image, proprietary) and paper. NHI can even pull accounts from your system if granted access.
- Provider Enrollment (or re-enrollment)
We complete and submit applications to the Medicaid programs enrolling your hospital as a provider for that state. Many applications we sign on your behalf if you approve. Those needing signatures are completed and sent to the hospital for signature.
All claims that arrive at NHI with complete documentation and an active provider number with the specific Medicaid program are billed within ONE business day! As many claims as possible are submitted to Medicaid or MCO electronically
- Follow up
We follow up aggressively on each account until it is resolved. Medicaid programs will notify us when an account is denied. We pursue all accounts that have been denied in error and report all accounts outstanding, paid or closed in our monthly reports to you.
We provide an extensive suite of reports. All reports are designed to provide accurate and up-to-date information about your accounts individually and collectively. Other reports are designed for you to monitor our performance. Access to these reports is available 24/7 on our secure client site.
It is our objective to work with our clients to take all steps necessary to minimize the need to file an appeal. If however an appeal is necessary we will file and follow up on your behalf. The above is a brief synopsis of our services to you.