Medicaid Eligibility Management Process

Medicaid Eligibility Management Table of Contents

1. Setup
2. Adding Bills to Medicaid Eligibility Management
3. When Active Coverage is Found
4. When No Coverage is Found

The Medicaid Eligibility Management feature is an automated way to consistently verify a patient's Medicaid Eligibility for a transport on or before the date of service of the bill. The system will check the patient's Medicaid Eligibility at scheduled intervals and if Medicaid Eligibility is found to be active, the bill will be automatically routed back to the biller who entered the bill into the Medicaid Eligibility Management feature. Bills will automatically leave the Medicaid Eligibility Management process if a set number of days have passed since the date of service of the bill to prevent timely filing issues. 

Before using the Medicaid Eligibility Management feature, please review AIM Intelligence Setup and configure appropriate settings for this feature.

Enable Medicaid Eligibility Management

Must be enabled as pictured in order to use the feature.

Check Medicaid Eligibility Every ___ Days

The Medicaid Eligibility Management process will automatically check the Medicaid eligibility for that payer every X days, where X is equal to the number entered in this field. A value of 7 can be entered to check weekly, 14 to check every 2 weeks, etc.

The system will automatically route bills back to the biller who entered the bill into the Medicaid Eligibility Management process when active Medicaid coverage is found. 

Release From Medicaid Eligibility Process After ___ Days

After a number of days from the date of service of this bill, specified in this field, that bill can be automatically removed from the Medicaid Eligibility Management process. 

Bills will automatically be removed from the Medicaid Eligibility Management process from this setting, or by the bill being sent to collections, whichever comes first.

Adding Bills to the Medicaid Eligibility Management Process

When conducting an eligibility check for a Medicaid-type payer, a new button will appear in the Eligibility Results section titled "Medicaid Eligibility Management". 

After clicking this button, the bill will be added to the Medicaid Eligibility Management scheduled process. Only one scheduled process can be active for a bill at one time, so while the bill is in the Medicaid Eligibility Management process, it cannot be added to the Deductible Management process, and vice-versa.

When a bill is entered into the Medicaid Eligibility Management process, a payer will be added to the bill using the payer from which the patient's eligibility was checked. This payer will be forced into an Incomplete status while the bill is in the Medicaid Eligibility Management process and allows the system to automatically verify that payer's eligibility at scheduled intervals.

Once the Medicaid Eligibility Management process is disabled for a bill, this payer will then begin enforcing validations from mandatory print/entry fields in Field Configuration Setup.

The Medicaid Eligibility Management icon displays on the bill after the button is clicked. The checkbox beside the icon can be clicked to remove the bill from the Medicaid Eligibility Management process. 

Each time a manual or automated eligibility check is conducted, the details for that eligibility check will be posted to this grid on a new tab within the Billing Module's Narrative Tab. When a bill enters or leaves the Medicaid Eligibility Management process, the information will be recorded here.

Bills in Medicaid Eligibility Management Report

In the Billing Reports > Status Reports category, a report and queue have been created that will assist with identifying bills actively in the Medicaid Eligibility Management process. The report/queue is titled "Bills in Medicaid Eligibility Management". See the help guide article for more information on how to use this report/queue.

When Active Medicaid Eligibility is Found

Once active Medicaid coverage is detected on or before the date of service of the bill through the process's automated eligibility checks, the bill will automatically be routed back to the user who entered the bill into the Medicaid Eligibility Management process.

From there, the biller should verify the latest eligibility results, then bill accordingly. The system will return results based on active coverage - but it may be that the eligibility results indicate that a Medicaid HMO plan would be billed instead. The results could indicate a pharmacy plan (like EPOMS), in which case Medicaid would not be billed. There are a number of circumstances where the payer will return 'active coverage' in the eligibility results - it just may be the case that regular Medicaid eligibility is not the coverage that is active.

If the system determines active coverage in the eligibility results, it will route the bill back to the biller, but these results might not always contain active coverage of Medicaid. Billers should always review the latest eligibility results after the system routes the bill to them. 

When No Active Medicaid Eligibility is Found

Manual Removal from Medicaid Eligibility Management Process

When the bill is removed from the Medicaid Eligibility Management process, the payer that was previously added to the bill will not be automatically removed and will need to be deleted if that payer will not be billed. However, this payer will not be added to the account's Member Payers.

Bills can be manually removed from the Medicaid Eligibility Management process by unchecking the checkbox next to 'Medicaid Management Active'.

After unchecking this box, it will disappear. Save the bill to remove it from the Medicaid Eligibility Management process. Afterwards, delete the payer if that payer will not be billed. 

If this box is accidentally unchecked, just disable edit mode to revert the bill back to Medicaid Eligibility Management status (this must be done before you Save the bill). 

Sent to Collections

Bills will also be removed from Medicaid Eligibility Management if they are sent to collections. If the user manually posts a 'SL - Send to Collections' transaction to the bill, it will automatically be removed from the Medicaid Eligibility Management process. This also happens if the Collection Report is configured to automatically update bills to a Sent to Collections status and it is used. 

Automatic Removal from Medicaid Eligibility Management Process

Bills that reach a number of days from that bill's Date of Service will automatically cycle out of the Medicaid Eligibility Management process. That number is determined by the Release From Medicaid Eligibility Process After ___ Days field in AIM Intelligence Setup.

Bills will also be automatically removed from the Medicaid Eligibility Management Process once that bill is closed. If a bill is removed from the process like this, then a record will be posted to that account's Medicaid Eligibility Management History Grid in the Accounts Module.