Safety-Net Medicaid Eligibility


By now, secondary eligibility has made a name for its self in the Hospital Revenue Cycle, but depending on your experience with this service there may be some mixed feelings about it. Typically, secondary Medicaid eligibility is used as a safety net behind primary vendors or in-house teams to maximize revenue recovery opportunities that may have been overlooked the first time. Some hospitals may choose a safety net vendor if they feel that their primary is under-performing or may opt out of this service if they feel that the eligibility team is surpassing conversion expectations. If your primary vendor is a lot to manage already, the thought of adding another vendor may seem cumbersome or you may fear it will cause interruption. The truth is that these assumptions are inaccurate for the most part, and there are several other factors to consider when determining if your hospital would benefit from a safety net service.

Safety net services are done completely behind the scene, are noninvasive to current processes and a contingency-based pricing schedule makes the recovery service risk-free. Because secondary cases are usually more difficult or are approaching deadlines, successful secondary vendors work referrals as thoroughly and rigorously as they would if they were the primary.

Do you feel like your Medicaid conversions should be higher? Has your third-party vendor become complacent on high or low dollar accounts? Are monthly reports leaving you uncertain about the data being received? A secondary vendor can ease those pains points by providing a closer look and offering expert advice.

If your hospital facility has more than 150 beds or a self-pay population of more than 10%, we strongly recommend a secondary eligibility vendor, regardless of the primary vendor’s performance. We have seen first-hand that adding some friendly competition to run eligibility behind the existing process can dramatically increase performance from all parties.


Bethany Bailey
Vice President and Eligibility Expert