More than 77 million Americans<\/a> rely on Medicaid for health insurance.<\/p>\n Yet enrolling individuals in Medicaid programs, connecting them to care, and facilitating payments for services can be challenging for organizations responsible for delivering these services.<\/p>\n With more states such as New York<\/a> and Oregon<\/a> harnessing their states\u2019 Medicaid 1115 waivers to pilot projects designed to better serve Medicaid members and address health-related social needs (HRSN<\/a>), streamlining Medicaid enrollment<\/a>, authorization, and reimbursement processes is becoming increasingly imperative for expanding access to critical social care services.<\/p>\n As more government agencies, health plans, providers, and community-based organizations (CBOs) engage in cross-sector initiatives aimed at advancing social care outcomes, doing this work efficiently, and at scale, is more important than ever.<\/p>\n Member eligibility verification is typically a time-intensive, cumbersome process, with care managers manually toggling between multiple systems <\/strong>to verify member eligibility and connect them to a CBO\u2019s services. Not only is this frustrating for staff, but it also means delays and bottlenecks for Medicaid members who need to be connected to vital resources. Without technology that helps care managers accelerate this process and centralize social care coordination<\/a>, resources are wasted and staff is placed under intense administrative burden.<\/p>\n Unite Us is solving this problem<\/strong> by integrating with states\u2019 Medicaid systems in real-time, eliminating the need to access multiple systems and reducing the administrative burden of manually verifying Medicaid eligibility and managed care enrollment each time services are needed. <\/strong>This integration enhances the Medicaid reimbursement process by seamlessly incorporating real-time verification into the workflow of Unite Us\u2019 scalable payments solution<\/a>, streamlining and automating a traditionally tedious process.<\/p>\n How does it work? First, a user adds insurance information to a member\u2019s profile. Unite Us automatically sends a request to a state Medicaid system to verify the member\u2019s insurance coverage with the selected plan. Users are notified if the member is eligible to be enrolled in the social care program. The system also re-verifies member coverage to ensure continued program eligibility, as members often transition in and out of Medicaid or have lapses in their coverage.<\/p>\n With this functionality, care managers can seamlessly verify a member\u2019s Medicaid coverage and eligibility for social care services with the click of a button, all within the Unite Us ecosystem.<\/p>\n The ability to seamlessly integrate with states\u2019 Medicaid systems in real time holds several advantages, including:<\/p>\n The Healthy Opportunities Pilot<\/a> (HOP), North Carolina\u2019s 1115 HRSN Medicaid demonstration waiver, authorized the reimbursement of $650 million for health-related social need (HRSN) services to Medicaid members.<\/p>\n This program by the North Carolina Department of Health and Human Services (NCDHHS) is the nation\u2019s first comprehensive program to provide evidence-based interventions\u2014including housing, food, transportation, interpersonal safety, and toxic stress support services\u2014to high-needs Medicaid enrollees<\/a>.<\/p>\n Working in partnership with NCDHHS, Unite Us recently launched an integration with North Carolina\u2019s MMIS system to streamline real-time member eligibility verification.<\/strong><\/p>\n Since the HOP program launched in March 2022, there has been an incredible impact with invoice metrics citing a 3% payer rejection rate<\/strong>1<\/sup> compared to the national denials rate of 18%<\/strong>2<\/sup> \u2013 and more than $70M has been reimbursed for health-related social needs<\/a> services as of April 30, 2024.<\/strong>3<\/sup><\/p>\n Integrating real-time member eligibility verification into social care technology is a significant step forward in the larger ecosystem of social care reimbursement programs. Now more than ever, closer interoperability between healthcare and social care technology systems results in increased efficiencies, empowering government, healthcare, and community organizations to support Medicaid populations in a more sustainable, scalable way. Pulling these various stakeholders together is a critical piece of doing this work at scale.<\/p>\n Now, insurance verification and program enrollment<\/a> can happen all in one system, allowing these organizations to collaborate and support Medicaid populations in a way they haven\u2019t been able to before.<\/p>\n While this work can be complex, the goal is simple: making sure that Medicaid members are receiving the benefits they\u2019re eligible for as efficiently as possible. Real-time member eligibility verification represents an important first step in this journey and makes it clear that there\u2019s an opportunity for all organizations, no matter how small, to shape the future of social care payments and build healthier, more resilient communities.<\/p>\n To learn more about Unite Us Payments<\/p>\nChallenges with Traditional Member Eligibility Verification and How Unite Us Is Solving Them<\/h2>\n
Key Benefits of Automated Member Eligibility Verification<\/h2>\n
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Customer Success Story: NCDHHS<\/h2>\n
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How Does this Simplify Reimbursement for Social Care?<\/h2>\n
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