Eligibility and Enrollment Services

Chamberlin Edmonds provides a practical, cost-effective way to qualify patients for a full range of benefit programs.

Since 1986, Chamberlin Edmonds’ experts have been providing eligibility determination services. Today, Chamberlin Edmonds is one of America’s leading patient eligibility and enrollment firms, offering effective solutions designed to drive down uncompensated care and target your unique challenges.

Chamberlin Edmonds can advise clients and process applications for a full range of benefits including local, state, federal and the healthcare exchange marketplaces.

Chamberlin Edmonds services
County/Local Programs
  • County indigent healthcare programs
  • Various other benefit programs targeting indigent, uninsured or underinsured
State Programs
  • Medicaid (all programs)
  • Crime Victims Compensation
  • State Children's Health Insurance Program
  • Charity Care
Federal Programs
  • Supplemental Security Income(SSI)
  • Social Security Disability Insurance(SSDIB)
  • Medicare
Health Insurance Exchanges
  • Assist patients in accessing insurance affordability programs including Qualified Health Plan enrollment

What are Chamberlin Edmonds' service offerings?

Patient Enrollment

Chamberlin Edmonds’ patient-facing employees assist patients in submitting applications real-time via wireless technology.

    Opt-In States
  • Customized outreach strategy for your market to enroll patients into the Medicaid expansion group
  • On-site Medicaid eligibility & enrollment
    Opt-Out States
  • On-site Medicaid eligibility & enrollment
  • Federal disability enrollment (SSDI & SSDIB)

Emergency Department Services

Chamberlin Edmonds has a unique model of a combined delivery of eligibility and enrollment services and Motor Vehicle Accident (MVA) services to Emergency Department patients.

  • Fewer handoffs and ‘one face’ to the patient
  • Increased recovery rates for patients involved in MVAs with Personal Injury Protection (PIP) coverage
  • Reduction in health denials associated with under-identified MVAs
  • Auto insurance will pay many accounts that might appear to have no other option other than self-pay thereby reducing aged AR and bad debt
  • Proven economic opportunity by focusing on finding Med Pay and Liability coverage on these accounts as well as increasing the amount and accuracy of patient information to the hospital

Health Insurance Exchange Enrollment

  • Approved by CMS as a multi-state Certified Application Counselor Designated Organization
  • The majority of patient-facing employees are Certified Application Counselors (CACs)
  • Application submission at point of care via wireless enrollment technology (with direct access to portals/Health Insurance Exchanges in several states)
  • Customized outreach strategy for your market to assist patients in accessing insurance affordability programs including Qualified Health Plan enrollment

Presumptive Eligibility

While hospitals assume overall accountability for Presumptive Eligibility process and results, new regulatory clarity allows vendors to assist in the process. Chamberlin Edmonds can help strengthen this process through eligibility expertise to assure accurate eligibility & enrollment determinations.

RevFinder Self-Pay Coverage Identification

RevFinder self-pay screening service is designed to provide a comprehensive review of all uncompensated and balance-after accounts to identify pre-existing government or commercial insurance.

  • Extends the human-driven patient interview with technology-based account monitoring
  • Monitors self-pay and charity-designated patient accounts for missed medical coverages
  • Enforces a uniform patient screening policy throughout the organization
  • Optimizes revenues through retrospective and ongoing account monitoring

Patient Financial Analytics Services - Medicaid, Charity & Propensity-to-Pay

Chamberlin Edmonds technology approach to presumptive Charity & Propensity-to-Pay provides an analytics based patient financial scoring service capable of integrating directly with hospital systems self-pay and collection workflows.

  • Enforces a uniform and unbiased charity screening policy throughout the organization
  • Increases patient’s access to charity care while identifying missed Medicaid opportunities
  • Optimizes costs of downstream collections though automated reclassification of accounts
  • Limits the number of misclassified patients though evidence-based scoring technologies

What benefits can Chamberlin Edmonds offer?

  • Increase revenue and reduce bad debt through the discovery of existing third-party coverage of patients who initially present as self-pay
  • Positive community relations
  • Reduced collection agency fees