Eligibility & Enrollment Solutions

Services for payers and providers that help to identify and support financially-vulnerable patients through payment counseling and program enrollment.

A Personalized Approach to Support Patients in Need

Improve outcomes by providing patient financial support

Change Healthcare helps hospitals and health systems reduce uncompensated care by identifying patient coverage. Our onsite staff consults with patients to determine their potential eligibility for enrollment in payment programs, provide financial counseling, and secure payment collections.

We also have over 15 years of experience in assisting payers to address plan members’ socio-economic determinants of health. By enrolling your members in the social programs for which they qualify, we help to facilitate their financial security, which can provide members with the boost they need to improve their personal circumstances and positively impact their health.

Reduce uncompensated care and bad debt for providers

The Eligibility and Enrollment Advocate solution suite is for hospitals and health systems that want to identify patient coverage to improve accounts receivable, reduce bad debt, and increase patient satisfaction by reducing out-of-pocket expenses.

Eligibility and Enrollment Advocate enables your team to stay focused on other patient access and revenue cycle tasks while we uncover appropriate funding sources and manage patient education and collections. Before a patient’s scheduled visits, onsite staff ensures patients understand their financial responsibility and have made arrangements, if needed. The Eligibility and Enrollment solution suite is ideal for Emergency Departments, inpatient and outpatient.

Help payers’ most vulnerable members receive the support they deserve

Our market-leading predictive analytics and machine learning capabilities offer a data-driven, patient-centric approach to social program qualification.  We help you identify, reach, and assist qualified members with enrollment in these programs.

Our experienced team of advocates meet with patients to learn more about their circumstances and support them throughout the enrollment journey. We see their program applications through to approval, and remain engaged with members to keep them enrolled.

Our solutions help to avoid uncompensated care, improve patient outcomes, increase member satisfaction and loyalty. Our solutions are designed to raise your quality ratings, increase revenue, and decrease the cost of care for both providers and payers alike.

Support Patient Finances to Impact Health Outcomes 

Identify Program-Eligible Members

Focus on those not claiming entitled benefits

We use predictive analytics and machine learning capabilities to develop an eligibility scoring model to identify members who are potentially eligible for social program enrollment. We confirm eligibility and help unenrolled members through the application and submission process.

We are experienced in helping patients claim benefits in a variety of programs, including Supplemental Security Income, Medicaid, Medicare Advantage, Medicare Part D, and dual-eligibility programs for senior members.

Increase Member Revenue Potential

Enrolled members earn higher capitation rates 

Members who are enrolled in social programs (partial/dual eligibility, Social Security disability, etc.) generally earn more revenue for a plan through higher capitation rates. Enrolled members also receive additional health benefits, leading to improved health outcomes, greater financial stability, and reduced cost of care for health plans.

Reduce Uncompensated Care & Improve Collections

Uncover coverage sources for self-pay patients

Eligibility and Enrollment Advocate provides support for enrolling patients in funding programs. Our onsite staff consults with patients to determine their potential eligibility for enrolling them in government funding sources at the federal, state, and local levels to secure payment.  Eligibility and Enrollment Advocate also helps ensure timely and accurate reimbursement of motor vehicle accident (MVA) and workers’ compensation claims, and helps to educate patients on available programs and assisting with application submissions.

Improve Patient Satisfaction & Loyalty

Impact your STAR ratings

Our personalized approach helps patients by addressing their most critical needs. We provide a hands-on approach that ensures each patient feels supported every step of the way.

When your most vulnerable patients receive the extra financial support they need and deserve, their health outcomes begin to improve. Patient satisfaction and loyalty also rises, which can lead to better STAR ratings for your hospital, health system, or health plan.

Explore Our Eligibility & Enrollment Solutions