ROI has 15+ years of Out of State Medicaid Billing experience in all 50 states.

Most facilities are not registered with Medicaid in every state. Because of this, if a patient is treated at a facility but the facility is not registered in the patient’s state, the facility would write off the cost of all of the treatment.

With ROI’s program, we handle everything for the facility and do the work to ensure payment. We take accounts from the facility, complete the enrollment packages, return them to the facility for approval, submit the claims, follow-up on the claims, and confirm payment. By utilizing ROI’s services, facilities that do not currently have an Out of State Medicaid program no longer have to write these accounts off as lost money.

Referral Process

  • Manual or electronic placements

Enrollment Process

  • ROI obtains and completes forms
  • We also provide re-enrollment and keep facilities up-to-date and active with payors
  • We ensure payment and report back on claims (i.e., performance reporting)
  • Need facility credentials and facility sign-off

Verification Process

  • Online Tools
  • Remote System Access
  • Handle Straight Medicaid and Medicaid Managed Care

Billing Process

  • Submit Directly on Payor Site
  • Paper billing
  • Adjust claims to State-specific Requirements
  • Handle Straight Medicaid and Medicaid Managed Care

Reporting

  • Individual Claim Status
  • Performance Returns – About 70% of the accounts are converted

Direct Payment Deposits

  • Some states offer or mandate direct deposit of payments

Rate Structure

  • Contingency is the typical rate structure
  • ROI can also provide a flat fee per account