Leaders in Eligibility

Chamberlin Edmonds excels in screening patients for eligibility and obtaining remittances from federal, state and community benefit programs. Hospitals rely on Chamberlin Edmonds to:

  • Screen patients and submit applications for all types of benefits, from obscure state programs to complex federal disability programs
  • Track every application through a maze of processes and regulations
  • Obtain high rates of successful outcomes

Every day, our professionals help hospitals and their patients recover millions of dollars that would otherwise be lost. Our eligibility services include Medicaid, Supplemental Security Income (SSI), Social Security Disability Insurance Benefits (SSDIB), state disability, charity care and many other community benefit programs. We act as your patients' advocate through the entire process and complete all necessary applications at no cost to them.

Examples of the cash remittances Chamberlin Edmonds has obtained for our clients:

  • In four years, St. Charles Health System has recovered over $33 million
  • In seven years, the Denver Health has recovered over $111 million.
  • In seven years, University of Louisville Healthcare has recovered over $167 million.
  • In five years, Jackson Health System has recovered $275 million.

Chamberlin Edmonds' working knowledge of federal programs and our relationship with federal agencies differentiates Chamberlin Edmonds from our competitors. Examples of these programs are:

Title II - Social Security Disability Benefits (SSDIB)

This is a federal insurance program for individuals who have been employed under the Social Security System or who have had a spouse or family member employed under the Social Security System.

Title XVI - Supplemental Security Income Benefits (SSI)

SSI is a federally sponsored program for individuals who are disabled under the Social Security Administration regulations. Medical requirements as well as income and resource requirements must be met.

Medicare for Disabled

This is a benefit of Title II disability, which starts 29 months after the onset of disability regardless of the individual's age. We also handle application for Medicare for aged patients who are unaware of their potential eligibility.

Medicare for End Stage Renal Disease

Our nation's first catastrophic illness insurance benefit has been quite successful in assisting both patients and health care providers in the treatment of permanent renal failure. These individuals, once qualified, can receive the dialysis and/or kidney transplants needed to sustain life.

Chamberlin Edmonds works with state and community programs to obtain funding for our customers as payment for services rendered to the indigent population. We know the programs specific to each state. Examples of these programs are:

  • Medicaid
  • Medi-Cal
  • ABD (Aid to Blind & Disabled)
  • TANF (Temporary Assistance for Needy Families)
  • LIF (Low Income Family Benefits)
  • Maternal Newborn Medicaid (Pregnancy Benefits)
  • Healthy Start (Benefits for Children Under Age 19)
  • EMA (Emergency Medical Assistance)
  • Crime Victim Assistance
  • SLH (State and Local Hospitalization Program)
  • Charity Care
  • Spend Down
  • Medically Needy

Chamberlin Edmonds understands that most states are facing the difficult challenge of balancing their budgets. A large proportion of each state's budget goes to programs for indigent and low-income residents. As costs continue to rise, states are restricting or eliminating these programs in an effort to reduce expenses. Health reform legislation will put additional burdens on states.

Chamberlin Edmonds helps states reduce costs by leveraging our experience as Supplemental Security Income (SSI) and Social Security Disability (SSDIB) specialists. Our professional staff of nurses, trained social services personnel and government program specialists identifies and qualifies individuals who are eligible for federal SSI and SSDIB.

Our solution is to shift the financial burden of individuals who now receive state cash assistance benefits to federally funded programs. The SSI recipient benefits as well. Generally, the cash assistance the SSI recipient receives is significantly more than what they would see from the state.

There are a variety of government programs. such as SSI and QMB (Qualified Medicare Beneficiary Program), which are available to help individuals with limited incomes. Typically these programs require assistance to enroll, and many patients do not apply for benefits for themselves. Enrollment in these programs can also have a significant impact on revenue received in a managed care plan. The capitated rates to manage these patients may either be driven up and/or fees may be reduced in plans by high cost members who are subsequently required to transfer to other plans. Our expert eligibility services are valuable to both Medicaid and Medicare Advantage Plans.

Medicaid Managed Care

A significant number of Medicaid Managed Care members qualify for Supplemental Security Income (SSI) benefits. Chamberlin Edmonds experts navigate through complex eligibility requirements to identify and qualify those members most likely to be eligible for federally funded disability benefits. We have developed a customized program to maximize results for Medicaid Managed Care which includes utilization of a proprietary system that identifies potential disability from medical claims files. We reach out to members where a significant number of the disabled are children. We find that children are often approved for government benefits quicker than the adult population. Most SSI recipients receive from $500 to $800 a month to cover their living expenses. By increasing the value of the managed care plan to its patients, Chamberlin Edmonds also helps improve member retention and reduce turnover costs.

Medicare Advantage Plans

Typically, up to 25 percent of Medicare members will also benefit from enrollment in QMB (Qualified Medicare Beneficiary Program), SLMB (Specified Low-Income Medicare Beneficiary Program), and Q1-1(Qualified Individual Program). However, these members don't receive the benefits because they lack information or the skills in getting approved. By identifying and qualifying these individuals who are covered under dual eligibility, Chamberlin Edmonds can help the Medicare Advantage Plan obtain and maintain higher capitated rates. Qualifying members also benefit from dual eligibility since these programs help Medicare beneficiaries of modest means pay all or some of Medicare's cost sharing amounts, such as premiums, deductibles and copayments.

Our professional staff has thousands of years of experience in the Medicare, Medicaid, Supplemental Security Income and Social Security Disability arenas. They are ready to help your MCO benefit from this underutilized opportunity. Now is the time to call in the specialists from Chamberlin Edmonds.