Making Bolder Outcomes a Reality.

Bolder Outreach Solutions provides Primary and Secondary Medicaid Eligibility Services to medical providers that will generate cash revenue for those uninsured patients who would otherwise fall into a charity or bad debt category.

At Bolder Outreach Solutions we understand the importance of patient relationships, and we strive to provide the very best patient experience possible. Our Patient Advocates connect with each patient and guide them through the complex eligibility process.

From start to finish, through hearings and appeals, we are there to represent them. But we also understand our responsibilities do not end there. That is why we lead the way in technological advancements with eligibility processes. Our technology development team has broken new ground with daily automated eligibility status and bill tracking inquiries through Medicaid intermediaries.

Our Patient Advocates are compassionate and highly trained individuals with a complete understanding of Medicaid, Supplemental Security Income, and other entitlement programs. In light of the Affordable Care Act, the majority of our Patient Advocates are Certified Application Counselors and are adept at helping patients enroll for health insurance coverage through the marketplace.

Our Patient Advocates are stationed at designated hospital access points to ensure we complete our interview and discovery process while the patient is at your facility. The staffing model deployed is customized to each facility based on peak times and desired coverage for specific intake points.

Our Patient Advocates conduct point of entry and bedside interviews of your uninsured and underinsured patients to determine if they categorically link to government assistance programs.

Each referred patient is evaluated based on State Medicaid guidelines and the Five-Step Sequential Evaluation used by the Social Security Administration.

The healthcare provider continues to deal with both a shortage of and cost to retain RNs and LPNs. We provide a solution to leverage clinical talent to render care at your patient’s bedside, while our team takes care of the business process of securing payer authorization.

We have a team of utilization review nurses on staff to complete medical reviews and secure authorizations. We follow each case for continued stay approvals and submit cases for appeal should an adverse determination be generated by the payer. When appropriate a reconsideration is submitted.

This program accelerates claims adjudication and reduces denials experience for your facility. Our program historically achieves a 97% approval rate for cases submitted and can be set up as either a temporary project or for ongoing support.

Our expert nurse auditors are highly proficient in identifying problem areas that negatively affect your Medicaid recovery. In most situations, our audits can be achieved through remote access without interfering with daily operational processes.

This service can be an invaluable tool when the Affordable Care Act is fully implemented so that providers receive every dollar of reimbursement they deserve.
We project that the government will be overwhelmed with the logistics of administering the ACA, and our service will assist you to identify any processing errors and rectify them.

We work to reverse denials of all or parts of patient stays. We have extensive experience working with state utilization review organizations and an excellent success rate in overturning denials. Our team also works with Utilization Management agencies determined by the patient’s residence state.

An example of a common issue we encounter: Part of the stay was denied for reasons such as time spent in an acute facility while case management researches nursing homes or LTAC’s for placement of the patient. We work to expedite a Medicaid Pending status for the patient, as is required before the transfer.