Post-PHE Crisis: Millions Losing Coverage for Paperwork Issues

70% of Medicaid disenrollments are procedural—not due to ineligibility. Is your hospital prepared for the revenue impact?

MEDICAID RECERTIFICATION SOLUTION

Turn Medicaid Nightmares Into Healthy Patients & Revenue

Keep patients healthy AND your revenue flowing. Our AI agents ensure no one loses coverage due to paperwork chaos—preventing emergency room visits, maintaining continuity of care, and protecting vulnerable patients. The result? Healthier communities and $9.4M average annual recovery for your hospital.

93% Patients Keep Coverage

$9.4M Average Recovery

82% Fewer ER Visits

67 Days Payback

93%

Procedural Disenrollments Prevented

82%

ED Visits Avoided

4.2X

ROI on Administrative Costs

2-5%

Revenue Volatility Eliminated

The $56 Billion Healthcare Crisis

Post-PHE unwinding has created a perfect storm: procedural disenrollments, ED overcrowding from delayed care, and revenue volatility that threatens hospital financial stability nationwide.

Procedural Disenrollments

Millions lose coverage for paperwork failures—not ineligibility. Outdated addresses, missed forms, and language barriers drive preventable write-offs.

70%

Disenrollments are procedural

ED Overcrowding Crisis

Disenrolled patients delay care until emergencies. EMTALA requires treatment but hospitals receive no payment, straining cash flow.

2-5%

Net revenue lost to uncompensated care

Revenue Volatility

Unpredictable payer mix shifts disrupt budgeting. Revenue cycle teams waste resources on retroactive eligibility verification.

$47K

Average per patient recovery

CRITICAL REVENUE THREAT

How Biannual Redeterminations Create a Revenue Perfect Storm

Biannual redeterminations amplify the revenue challenges from the 2023-2024 unwinding, creating a perfect storm that threatens hospital financial stability

FEDERAL SAVINGS AT HOSPITAL EXPENSE

$63.8 Billion

Over 10 years from reduced enrollment

UNINSURED BY 2034

+700,000

Due to administrative hurdles alone

70% Procedural Terminations

30% Actual Ineligibility

Evidence from Texas shows children with twice-yearly renewals face double the disenrollment rates

CRISIS POINT #1

Higher Churn & Coverage Losses

Eligible patients losing coverage temporarily due to:

Missing mail notifications

Paperwork burden overload

Language & literacy barriers

Result: Hospitals treat uninsured patients, face denied claims and delayed payments

CRISIS POINT #2

Increased Uncompensated Care

More frequent checks = more procedural terminations:

Patients shift to emergency departments

EMTALA requires treatment

Hospitals absorb all costs

Impact: Bad debt could increase by billions, with 2-5% net revenue losses

CRISIS POINT #3

Administrative & Operational Strain

Revenue cycle teams overwhelmed by:

More frequent eligibility verifications

Assisting with reenrollments

Managing payer mix volatility

Cost: Added staff time, technology upgrades, revenue forecasting chaos

THE SOLUTION

How Our Orchestrated Solution Transforms This Crisis Into Recovery

Our comprehensive solution orchestrates six specialized AI capabilities that work 24/7 to prevent every procedural disenrollment, turning potential write-offs into recovered revenue

Proactive Risk Detection

Identifies at-risk patients 60+ days before coverage lapse

93%

Prevention Rate

Automated Outreach

Multi-channel contact to update info & overcome barriers

82%

Contact Success

Application Assistance

Guides patients through complex renewal forms in any language

96%

Completion Rate

Document Management

Validates & tracks all required paperwork automatically

100%

Accuracy

Real-time Support

Resolves issues before they cause coverage gaps

4.8/5

Patient Satisfaction

Continuous Optimization

ML adapts to policy changes & improves success rates

47%

Bad Debt Reduction

The Bottom Line Impact

$9.4M

Average Annual Recovery

67 Days

To Positive ROI

2-5%

Revenue Volatility Eliminated

Protecting Your Most Vulnerable Patients

Expansion enrollees often include low-income workers with chronic conditions. Coverage disruptions delay preventive care, leading to costlier emergencies. Combined with work requirements and other barriers, this provision will hit your sickest, most vulnerable patients the hardest.

Our AI agents ensure no patient falls through the cracks—protecting both their health and your hospital's financial stability.

LIVE DEMO

Watch Our Solution Save a Patient's Coverage

See how our orchestrated solution coordinates 6 specialized AI capabilities over 90 days to prevent a Medicaid coverage lapse and recover $47,000 in revenue

Patient #47823 - Maria Rodriguez

Medicaid beneficiary • Knee surgery scheduled Day 95 • Spanish speaker • 2 children

Day 0 of 90

At Risk

Coverage Status Timeline

At Risk

Critical

Secured

Risk Level ↑

Coverage Saved ✓

Day 95: Knee Surgery

Day 0

Day 15

Day 30

Day 45

Day 60

Day 75

Day 90

Goal: Ensure Coverage

Before scheduled procedure

Orchestrating Coverage Verification Before Procedure

Monitoring Agent

Risk Detection AI

Risk Detected!

Coverage Alert

Outreach Agent

SMS Campaign

Phone Outreach

Follow-up

Application Agent

Form Assistance

Renewal Support

Document Agent

Validation

Missing Docs!

Final Review

Support Agent

Patient Support

Issue Resolution

Analytics Agent

Risk Analysis

ML Update

Procedural Disenrollment Prevented • $47,000 Revenue Recovered

Maria kept her coverage despite outdated contact info and language barriers. No emergency room visit needed. No uncompensated care. No revenue volatility. This is how AI prevents the post-PHE crisis from impacting your bottom line—one patient at a time, thousands of times per month.

How Orchestration Delivers Results

EARLY DETECTION

Monitoring catches issues 60+ days before lapse

COORDINATED ACTION

Agents work together for 95% resolution rate

CONTINUOUS LEARNING

Analytics optimizes every agent's performance

Eliminate Administrative Burden

Stop spending hours on manual eligibility verification. Our AI agents integrate seamlessly with your systems to automate the entire process.

Epic

Cerner

Athenahealth

Allscripts

NextGen

eClinicalWorks

ISO 27001 Aligned

HIPAA Compliant

FERPA Compliant

Cut verification time by 87% • No more retroactive eligibility checks • Automated reenrollment assistance

Turn Medicaid Nightmares Into Healthy Patients & Revenue

93%

82%

4.2X

2-5%

The $56 Billion Healthcare Crisis

Procedural Disenrollments

70%

ED Overcrowding Crisis

2-5%

Revenue Volatility

$47K

How Biannual Redeterminations Create a Revenue Perfect Storm

$63.8 Billion

+700,000

Higher Churn & Coverage Losses

Increased Uncompensated Care

Administrative & Operational Strain

How Our Orchestrated Solution Transforms This Crisis Into Recovery

Proactive Risk Detection

Automated Outreach

Application Assistance

Document Management

Real-time Support

Continuous Optimization

The Bottom Line Impact

$9.4M

67 Days

2-5%

Protecting Your Most Vulnerable Patients

Watch Our Solution Save a Patient's Coverage

Patient #47823 - Maria Rodriguez

How Orchestration Delivers Results

Eliminate Administrative Burden

Ready to Eliminate Medicaid Write-Offs?