State and Federal Claiming

We work with state agencies to enhance their ability to improve their federal claiming processes, find new revenue opportunities, and coordinate with other payers to capture revenue whenever possible. With a deep knowledge of federal Medicaid regulations, we are able to maximize opportunities, while ensuring compliance with all applicable state and federal rules. 

Examples of our work include the following:

  • Collaborating with the Medicaid federal reporting unit in the Commonwealth of Massachusetts to automate its reporting function through the creation of a web-based system that produces superior information and results.
  • Providing Massachusetts and Texas with comprehensive medical billing and accounts receivable, as well as other services, to maximize the collection of federal, third-party, and private reimbursement for health care and related services provided by public hospitals, mental health clinics, psychiatric hospitals, skilled nursing facilities, and community-based programs.
  • Maximizing and claiming allowable reimbursement for direct medical services to Medicaid-eligible students — as well as associated administrative activities — that qualify for federal reimbursement.
  • Providing necessary compliance calculations required by the federal government, such as upper payment limit calculations, and disproportionate share limit calculations.
  • Ensuring that the state Medicaid program is the payer of last resort by effectively pursuing payment from other entities for services provided to Medicaid recipients.