patient eligibility verification

Yes. Medicaid periodically comes under political pressure, and changes to specific regulations such as the continuous coverage requirement or patient eligibility may impact patient coverage. This means that states may review the eligibility of every person enrolled in Medicaid, and increase the number of uninsured patients seeking care at hospitals. This could also increase financial challenges for providers that do not have a robust system in place for verifying eligibility.

To stay on track with changes to Medicaid, we recommend implementing best practices, such as regularly running insurance eligibility checks throughout the patient encounter. We also recommend utilizing solutions like SSI PBE as a final safety net for checking eligibility. By being proactive, you can minimize the potential negative impact of the unwinding process on your patients and your bottom line.

SSI PBE complements your existing front-end eligibility workflows by acting as a final verification step before claims are submitted. It helps catch issues that may have changed after registration or were missed earlier in the process.

Yes. We designed SSI PBE as an add-on to SSI’s Edits library and integrates easily into existing billing workflows without requiring major operational changes.