Medicare Eligibility Enhancement Services

Medicare is the largest single source of third-party liability savings for state Medicaid programs. By maximizing Medicare benefits for Medicaid members, states can expand access while creating cost savings and revenue opportunities. We understand eligibility policies and procedures, and the federal processes that impact state Medicaid members.

What Challenges You

Many Medicaid programs don’t have the specialized expertise to fully evaluate their populations for potential Medicare benefits—and may not identify additional opportunities for enhanced Medicare savings.

As a result, your state can miss populations of Medicaid members who may qualify as dually eligible, lose out on potential Medicare cost savings, or overpay for Medicare premiums. This can cost members valuable benefits and states millions of dollars.

Why Choose Us

We take a specialized, analytical approach, applying our deep understanding of federal rules and proprietary software tools to help state agency partners achieve meaningful results. Our Medicare eligibility and coordination methods go beyond routine those performed by states or other vendors. Our approach sets us apart, achieving more significant results.

How We Can Help

  1. 1

    With proprietary data integration and advanced data analysis, our Medicare Data Assurance Review compares federal and state data sources to identify and validate new Medicare coverage information not updated in state Medicaid systems.
  2. 2

    Our innovative Medicare enrollment support process integrates data analysis, customer service, and SSA coordination to reach potentially Medicare-eligible, but not enrolled, Medicaid populations. We assist these members through the entire Medicare application and enrollment process, helping ensure as much coverage as possible and, in some instances, cash SSDI benefits.
  3. 3

    Medicaid members under 65 with disabilities who receive Supplemental Security Income (SSI) may also be eligible for Medicare. We use a proprietary data mining and analysis application to identify missed benefits and provide documentation to SSA for review and correction.

Our Impact

Coverage Realigned. Millions Saved.

Using proprietary data integration and data analysis techniques to identify previously missed Medicare coverage among Medicaid recipients, we’ve identified over $70 million in cost savings for one state. Every dollar saved means they are running their program with integrity, maximizing revenue and maintaining member benefits.

In addition, we coordinate with SSA to reach Medicaid populations potentially eligible, but not enrolled, in Medicare—with a >95% success rate for Medicare enrollment cases processed by SSA.