Enrollment checks and payment recovery

Care is delivered, and then payment depends on things that change without warning: a resident’s Medicaid enrollment, their patient liability, a renewal that lapsed, a notice nobody saw. Checking is done by hand, one resident at a time, through a state portal. The aim is the capacity of a much larger follow-up team, and more payments collected for care already delivered.

Before building anything we read the source record. Public sources only; no resident data was used or requested.

The field exists

The state Medicaid provider portal exposes patient liability in its eligibility panel, per the portal’s published user guide.

The census view is restricted

A long-term-care roster view shows a full census with a patient responsibility column, but only to providers eligible to bill long-term-care claims.

Delegated access is a documented feature

The portal lets a provider add named agent users under its own ID with assigned roles. That is the authorized path for an agent account.

There is an electronic notice channel

Accounts set to paperless receive notices by email, and an authorized representative can be designated under federal rule 42 CFR 435.923.

The rules moved this year

The state personal needs allowance changed in 2026, and uncovered medical expenses are deducted over six months. A number built on last year’s rule is wrong today.

Renewals are where residents drop

Renewal is mandatory every twelve months, and a 90-day reconsideration window follows a procedural drop. Both are dates an agent can watch.

Nobody serves this segment

Facility RCM vendors work for the facility. Dental verification vendors serve practices billing insurers. The work in between is done by hand.

1. 01 · CHECK

   Start from the resident roster. Use an authorized portal account to check enrollment and patient liability regularly. Save each result so changes are visible month over month.

2. 02 · CATCH

   Catch approvals, missing notices and enrollment gaps. Retrieve the Notice of Case Action where available. Prepare renewal packets before a drop and reconsideration documents after one.

3. 03 · FOLLOW UP

   Identify whether the facility or the family handles payment. Prepare messages with the relevant notice, amount and service period. Track responses and schedule further follow-up.

4. 04 · RECONCILE

   Keep a record from the first issue through to payment. Reconcile collections with the client’s own records so results reflect cash received.

• Log in to a real portal without an authorized agent account. The demo runs on a clone until the client grants one through the portal’s own delegation feature.
• Sign documents. Attestation only. A named member of staff approves every communication and submission during the pilot.
• Move money or bill families. It prepares and tracks. People send and collect.
• Resolve an unclear case. Unclear cases go to a named person for review.

The business case is built from the client’s own ledger: billed amounts, collections and unpaid balances for the same period, with recorded write-offs reviewed separately and accounts split by who pays. It shows where money is held up, what action could release it, and the cost of that work. The pilot tests accuracy, staff effort, cost and actual collections, against a baseline defined before work begins.

When early estimates of the problem did not reconcile with each other, we said so, and led with unit economics per resident-month rather than an aggregate nobody could defend.