Out-of-State Medicaid
Out-of-State Medicaid
OOS Medicaid is perhaps the most challenging segment of complex claims. Hospital systems commonly write off these claims and many complex claims vendors do not handle this segment.
Why is it so complex?
- OOS Medicaid claims can be difficult to identify given the emergence of Managed Care
- Billing requirements vary significantly from state to state
- These varying requirements change frequently making them very difficult to manage
- All providers must be credentialed (physician and facilities enrolled) in the covering state before reimbursement can occur (almost no providers are proactively credentialed in other states)
- Re-credentialing is necessary with varying timelines; again, rules are different for each state
Aspirion manages all of the above complexity while ensuring timely billing and follow up to maximize reimbursements and to shorten the A/R cycle. We leverage electronic claim submission, produce custom reporting, and adhere to strict data security standards to ensure this often overlooked segment of provider RCM receives the care and attention that it deserves.