Finding Missing Coverage, Improving Your Bottom Line

Nemadji’s back-end Eligibility Detection service combines the extensive knowledge of our team with an advanced logic system to review outstanding patient accounts for eligibility verification across Medicare, Medicaid, and commercial insurance. This combination of automated and manual processes can uncover missing or unknown coverage that means increased revenue for hospitals. 

It excites us to find patient eligibility that others miss — and then deliver clean, verified results that translate into revenue that would otherwise be lost, and patient account resolution that may not otherwise happen.

  • We can help boost patient satisfaction by finding coverage on accounts that were previously classified as self-pay
  • We don’t collect from patients to achieve our results
  • We have extensive experience working with state Medicaid systems including Medi-Cal, EMedNY, Medical Assistance, Promise, and HUSKY
  • We have success with all types of accounts — IP, OP, ER

Post-Service Account Timeline

Nemadji’s Eligibility Detection service works seamlessly with existing systems and processes to complement and enhance current efforts, at any point in the post-service timeline.

Patient

Early Backend
Eligibility Vendors

Early Out Self-Pay Vendors

Bad Debt Solutions

(Patient Collections)

Denial Management

Eligibility Detection

This placement prevents patients from going to collections

Eligibility Detection

Eligibility Detection:

Last in Line©
Safety Net


Our Eligibility Detection Process

We identify a variety of inaccuracies, such as data anomalies hidden by transposed numbers, patient identification inconsistencies, coding mistakes, patient registration errors, and discrepancies in eligibility sources.

After Client
Data is
Received,
Computer
Match is Run

Human
Match is
Performed As
Needed

Eligibility
Verification is
Triggered Based
on Your Desired
Schedule

Accounts
Having Active
Coverage are
Manually
Reviewed by
Nemadji's Staff

Accounts are
Billed and
Monitored for
Payment or
Denial

Denial
Follow-up is
Performed,
if Needed

Accounts
Paid and Reports
Delivered
Showing Net Recoveries &
Actionable Data
for Potential
Stopgaps

Our People Make the Real Difference

Our dedicated and experienced team discovers revenue that would otherwise be lost — revenue that goes straight to the bottom line.


Problem Solving Is Second Nature

Because our team has longevity and expertise, we know more and can do more for our clients — resulting in less hassle, cleaner results, and stronger solutions. We pride ourselves on using the perfect combination of innovative, smart technology and human analysis to ensure a superior client experience.

We are proud to do this work. We are proud to be Nemadji.
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