Case Study
Enrollment Issue

Client Overview

The client is a healthcare provider specializing in primary care services, heavily reliant on Medicaid reimbursements for their revenue. They were facing significant challenges with claim denials due to enrollment issues, such as the provider not being enrolled with Medicaid and its managed care plans.

Challenge

The primary challenge was that the provider was not enrolled with Medicaid, which was a major payer for the practice. Medicaid and its managed care plans were denying a substantial number of medical billing claims. This situation severely impacted the provider’s cash flow and overall financial stability, creating an urgent need to address the enrollment issue to ensure continuous reimbursement for services rendered.

Coding Denials

Blue-Cross-Blue-Shield

Decreased Revenue

Our Solution

Enrollment Process Initiation

Our enrollment team initiated the process to enroll the provider with Medicaid and its managed care plans. This involved gathering all necessary documentation, completing detailed applications, and ensuring all submissions were accurate and comprehensive.

Backdated Enrollment Application

We submitted the enrollment application to Medicaid, requesting a retroactive effective date of six months. This step was crucial to secure reimbursement for past services rendered during the out-of-network period.

Close Monitoring & Follow-up

Our team closely monitored the progress of the enrollment application, maintaining regular communication with Medicaid representatives to expedite the process and address any issues promptly.

Claims Resubmission

Once the provider was credentialed, we assisted in resubmitting previously denied claims to Medicaid and its managed care plans to recover lost revenue.

Solution Image
Results Achieved

Successful Enrollment

The provider was successfully credentialed with Medicaid and its managed care plans, including approval for retroactive enrollment.

Recovery of Lost Revenue

By resubmitting previously denied claims, the client recovered a significant portion of revenue that was initially lost due to enrollment issues.

Improved Cash Flow

With the enrollment issue resolved, the client experienced a substantial improvement in cash flow from Medicaid reimbursements for both old and new claims.

Enhanced Financial Stability

The comprehensive RCM services provided by Med Bill Ultra streamlined the client’s billing processes, reduced denials, and ensured consistent and timely reimbursements.

Successful Enrollment
0%
Recovery of Lost Revenue
0%
Improved Cash Flow
0%
Enhanced Financial Stability
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Conclusion

By leveraging our expertise in enrollment, Med Bill Ultra successfully addressed the client’s critical issue of Medicaid claim denials. Our proactive approach not only resolved the immediate enrollment problem but also facilitated the recovery of past revenues and improved ongoing cash flow. The client’s decision to fully transition their RCM billing services to us underscored the value and effectiveness of our comprehensive billing and enrollment solutions, leading to sustained financial stability and growth for their practice.

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