Overcome the Challenges of Out-of-State Medicaid

Jul 17, 2020 11:36:54 AM / by Aspirion

Especially for facilities near state borders, out-of-state Medicaid claims can cause huge headaches. Many hospitals just consider it write-off business. But this outlook leaves millions of unclaimed dollars on the table—and we can help you get that revenue back.

This case study illustrates our commitment to seeing Medicaid approvals through to the end—whether they’re in-state or out-of-state.

When patients cross state borders to receive care at your facility, out-of-state Medicaid claims increase and often remain unpaid. These patients may become repeat visitors if your organization is located near state lines. Unfortunately, each subsequent visit presents more hoops for your staff to jump through—from individualized Medicaid program rules to regulation updates. Viable revenue hangs in the balance.


Billing requirements change frequently, varying from state to state, which complicates the task of tracking regulations. Your team must stay on top of 50 sets of requirements, limiting your efficiency. Overlooked processes will delay reimbursement and ultimately lead to lost revenue. Our team is committed to staying up to date on the latest processes to ensure your healthcare facility gets reimbursed quickly.

Each state also has its own credentialing requirements for facilities and providers. To ensure successful reimbursement, facilities and physicians must maintain their credentials in adherence to each state’s individual timelines, which requires long-term attention and investment. Unfortunately, few organizations have the time or resources to devote to such a detailed, ongoing process.

At Aspirion, we leverage electronic claim submission, produce custom reporting, ensure comprehensive physician and facility credentialing, and adhere to strict data security standards to give this often-overlooked segment of provider Revenue Cycle Management the care and attention it requires.
Want to see our work in action? Take a look at this eligibility & enrollment services case study.


Tags: Medicaid, Reimbursement


Written by Aspirion

Since 2008, Aspirion has offered a growing array of RCM services for hospital, health systems, and large physician groups looking for better results in managing their most complex reimbursements. Aspirion has been and continues to be a trusted partner to many of the most prominent providers in the U.S.