OUR MEDICAID ELIGIBILITY PROGRAM

At DeBiase & Levine Associates, Inc., our program is designed to maximize and expedite hospital recovery of potential Medicaid revenue by assisting your uninsured and underinsured patient populations in completing the process of applying for state governmental medical benefits. Through the use of our knowledgeable social services staff, we skillfully provide one-on-one advocacy services to your patients helping them through what is often times the daunting task of establishing their entitlement to benefits.

Our staff is available to meet with patients bedside to timely initiate the benefits application process and to follow up in the home shortly following discharge.

Advocacy Services

Assisting the patient bedside with completion of their application for Medicaid benefits materials and the assembly and procurement of required supporting documentation, including:

In-home follow up activity with patient following discharge,
Screening for and assisting in establishing Presumptive Eligibility for expedited receipt of Medicaid benefits,
Accompanying or standing-in for the patient at interviews with government agency staff,
Representing the patient’s and hospital’s interests in administrative fair hearing proceedings to contest unjust denial of Medicaid benefits, and
Assisting patients in the application and qualification for Social Security Disability benefits to maximize Medicaid and DSH revenue.

Our Medicaid Programs Include:

Pennsylvania Medicaid Eligibility/DSH
Presumptive Eligibility
Out-of-State Medicaid Eligibility/DSH
Medicaid Billing and Provider Appeal Resources
Disability/SSDI/SSI Benefits

On-Site Projects

DeBiase & Levine will maintain a daily onsite presence at your hospital to screen your uninsured and underinsured patients for potential Medicaid eligibility and to immediately initiate an application for benefits whenever appropriate. At the hospital’s request, we will set up onsite a full time operation to accommodate your patients’ Medicaid application needs.

Recognized Community Partner

DeBiase & Levine is recognized by the Pennsylvania Department of Human Services as a Community Partner, authorized to submit online COMPASS applications for Medicaid benefits on behalf of Pennsylvania residents. Our staff are individually registered participants with the COMPASS program.

COMPASS

DeBiase & Levine as a Community Partner and as a hospital provider representative will submit online applications for Pennsylvania Medicaid Benefits, inclusive of Presumptive Eligibility benefits, on behalf of the patients whom we are assisting. The submission of a COMPASS application not only streamlines the application process, but provides for the locking in of a timely application submittal as well as maximizes the allowable time frame for the pursuit of retroactive Medicaid benefits.

Medicaid Eligibility and Disproportionate Share Hospitals (DSH)

Pennsylvania Medicaid Eligibility

Our goal is to whenever possible qualify your uninsured patients under a DSHeligible category of Medicaid, including the pursuit when appropriate of a disability determination through either the Medicaid Program or the Social Security Administration.

Out-of-State Medicaid Eligibility

Our staff has years of experience acquiring proficiency in assisting out-of-state patients applying and successfully qualifying for Medicaid benefits in their home state. As in Pennsylvania, we seek out-of-state Medicaid benefits in categories that would bolster the hospital’s entitlement to DSH revenue.

Presumptive Eligibility

Patients will be screened bedside for potential qualification for expedited Medicaid benefits under Pennsylvania’s Presumptive Eligibility (PE) Program. Our staff will assist in the screening and completion of the PE application materials on behalf of patients appearing to be candidates for PE consideration.

Billing and Provider Appeal Resources

Our staff are available to support the hospital’s Medicaid billing function, including the preparation of 180-day exception request materials to justify qualification for an exception granted for payment of a delayed billing. DeBiase & Levine will also assist in the filing of provider appeals.

Disability, SSDI, and SSI

To maximize Medicaid reimbursement and also DSH entitlement, DeBiase & Levine will, whenever dealing with a potential disability situation, simultaneously assist your patient pursue Medicaid benefits in conjunction with seeking disability benefits in the form of either Social Security Disability Insurance or Supplemental Security Income. We will pursue a disability determination through either the relevant state Medicaid agency or the Social Security Administration. A disability determination not only qualifies for DSH consideration, but may very well serve as the only avenue to qualify a patient for Medicaid benefits.

Marketplace Screening and Referral Services

DeBiase & Levine will screen candidates for Marketplace enrollment whose income exceeds the allowable limit for Medicaid benefits. We can refer a Marketplace candidate to an experienced insurance broker with whom we have professionally interacted for several years. The licensed broker will calculate the patient’s eligibility for a subsidy to help defray or virtually eliminate premium costs, as well as assist the patient in reviewing plan options. The broker can make an insurance plan recommendation that best meets the patient’s medical usage, prescription needs and provider preferences, and can enroll an interested patient in his/her selected plan.

Third Party Payer Recovery

Additional hospital services we provide include resolution of insurance claims delayed or denied payment. DeBiase & Levine’s resources include staff trained in procuring relevant documentation needed to complete an insurance claim held up in the payment cycle due to lack of information furnished from the patient claimant. We are adept at identifying the responsible carrier and resolving COB claim issues.

Coordination of Benefits

D&L will assist patient in providing updated insurance coverage information to carrier withholding payment of claim. DeBiase & Levine will identify the responsible carrier and, once updated information is provided, will confirm with the carrier that insurance information is updated and claim is being processed.

Medicare Secondary Payer (MSP)

Program designed to resolve accounts hung up in the Medicare billing cycle where payment has been suspended until such time that information is provided as to other carriers that may or may not be primary, e.g. group health plan, retiree health plan, Worker’s Compensation, motor vehicle First Party no-fault benefits, motor vehicle liability benefits, etc. DeBiase & Levine will investigate the patient’s circumstances and make a determination as to which payer is primary, be it Medicare or one of the commercials, and follow up with the responsible payer until the claim pays.

Motor Vehicle First Party/PIP Benefits

DeBiase & Levine will assist patient in completing application for First Party/PIP medical benefits for submission to responsible motor vehicle carrier for payment of hospital bill incurred as a result of injuries sustained from a motor vehicle related accident. We will submit completed claim to responsible motor vehicle carrier including the retrieval of a police accident report. DeBiase & Levine will review payment to ensure compliance with Pennsylvania’s Cost Containment provisions mandating payment of full hospital charges for trauma treatment. Our staff is well versed in the payment provisions of PA’s no-fault Motor Vehicle Financial Responsibility Law.

Act 81: Mandatory Health Care Coverage For Newborns

Program is designed to secure 31-day automatic newborn insurance coverage pursuant to Pennsylvania’s Act 81 for newborns of commercially insured parents. DeBiase & Levine will also assist in obtaining ongoing insurance coverage of newborns beyond 31 days via enrollment in an insured parent’s plan. DeBiase & Levine will work with both the family and the insured parent’s employer to obtain the first 31 days of automatic coverage and then with enrollment of the newborn with the parent’s insurance plan for continuing coverage beyond.

Patient Locator Resources and Skip Tracing Techniques

We have a full range of skip tracing techniques including door-to-door home visitations by DeBiase & Levine staff along with online patient locator resources utilized to enhance our effectiveness in communicating with an often-times transient population.

Contact Us

Would you like to learn more regarding our services?