Eligibility Today

A Partner to Navigate Eligibility

There are numerous financial and medical assistance benefit programs, many of which system administrators are forced to recognize but are not prepared to manage.  Determination of eligibility varies with each program and the quality of medical care is often dependent on qualifying patients for specific programs.   Today’s healthcare administrator must have the business processes and systems to meet the demands of navigating a full spectrum of eligibility programs including all qualification guidelines and application processes.

UnivERS allows the administrative agency to quickly and accurately respond to any financial or medical assistance benefit program on behalf of their members. Regardless of the requirements or approval process, UnivERS with its “universal” application across any program, can have significant impact in the ultimate delivery of quality patient care.   That means providers can do more for their patients in less time and ensure payment.  Patients get the care they need when they need it and the providers of these services get paid appropriately.

The following is some helpful information for your practice to be better prepared to meet eligibility requirements for various programs:

  • Document all policies and procedures affecting member/patient eligibility
  • Identify individual eligibility programs, and related groups of programs
  • Define benefit plans and packages based on the breakdown (or carve-out) of the eligibility programs
  • Define the “rules of eligibility” for each program, carve-out, or benefit plan
  • Identify the target population and providers of each program or plan
  • Prototype and test eligibility rules for each program or plan against the population of each program or plan, and document any variances
  • Contract with Providers to support these programs or plans
  • Implement eligibility rules for each program or plan and monitor plan populations to ensure policy compliance
  • Monitor Provider and member feedback to ensure the programs or plans are working as expected

For more information on UnivERS, contact MariChris.