Unite Us Introduces Real-Time Medicaid Member Eligibility Verification to Increase Enrollment and Streamline Reimbursement for Social Care

New integration reduces administrative burdens by integrating with Medicaid systems to swiftly verify eligibility, enroll members in essential social care programs, and coordinate billing from a single unified system.

May 20, 2024 9:00 AM EDT | Source: Unite USA Inc.

New York, New York--(Newsfile Corp. - May 20, 2024) - Unite Us, the nation's trusted technology partner for social care transformation, announces new functionality to enable real-time Medicaid eligibility verification without leaving the Unite Us ecosystem. By integrating with states' Medicaid systems in real-time, Unite Us eliminates the need to access multiple systems and reduces the administrative burden of manually verifying Medicaid eligibility and managed care enrollment each time services are needed.

Unite Us is the first social care technology solution to integrate real-time member eligibility verification with closed-loop referral management via X12 EDI 270/271 transactions. This embedded capability empowers care managers to seamlessly verify Medicaid eligibility in order to connect qualified members to vital social and healthcare services and is a critical function for organizations to confirm the appropriate health plan to bill in order to be reimbursed for Health-Related Social Needs (HRSN) services.

The Healthy Opportunities Pilot (HOP) launched by the North Carolina Department of Health and Human Services recently implemented the capability to verify member eligibility within the Unite Us closed-loop referral platform. Care managers can tie Medicaid information to a person's record to be automatically notified about their Medicaid eligibility status. Not only does this help facilitate social care, but also ensures Medicaid members promptly address lapses in coverage.

"The Healthy Opportunities Pilot is a first-of-its-kind innovative program that is described as a 'life changer' for thousands of North Carolina families," said Maria Ramirez Perez, Associate Director for Healthy Opportunities. "The success of HOP is a product of collaboration with partners across the healthcare, social support, and technology sectors. The ability to integrate our Medicaid Management Information System (MMIS) with Unite Us has improved our social care reimbursement workflow in verifying Medicaid eligibility. As we were looking for efficiencies and time savings for our system's Care Managers, integrating our MMIS was a big win."

"By leveraging this functionality, we can now allocate HOP's resources more efficiently and effectively, ensuring that Medicaid members receive the support they urgently need in critical areas such as housing, food security, transportation, interpersonal safety, and toxic stress mitigation. This builds on the existing long-time partnership between HOP and Unite Us, underscoring our commitment to delivering targeted assistance where it matters most and ultimately improving health outcomes and fostering stronger, more resilient communities," Perez added.

The functionality builds on Unite Us Payments, an integrated capability that enables reimbursement for social care services at scale from within the referral platform, to further streamline the reimbursement process for community-based organizations (CBOs) and providers delivering services. Several states rely on the payments solution as a key component of their Medicaid initiatives' infrastructure, including Oregon, where nine Coordinated Care Organizations are currently utilizing Payments to streamline Medicaid billing for CBOs under their HRSN climate benefit program.

The Payments functionality is embedded into the closed-loop referral workflow, making it easier for healthcare providers, CBOs, and Medicaid agencies to collaborate efficiently and seamlessly in delivering and evaluating social care services. The expansion to include Medicaid eligibility information leads to improved accuracy and promptness of Medicaid reimbursements, and also expands the infrastructure's scalability for social care funding.

"This new integration is a significant milestone in our mission to broaden access to vital social services," said Raffaelle Breaks, Chief Product and Technology Officer at Unite Us. "With Unite Us member eligibility verification, we equip care managers with the ability to check for Medicaid eligibility ahead of enrollment, ensuring timely support for beneficiaries and a more efficient workflow for care managers."

Unite Us member eligibility verification integration exemplifies the unwavering commitment to driving social care integration into key state systems and expanding efficient access to vital social care services for Medicaid beneficiaries across the country.

Healthcare providers, government agencies, and CBOs seeking to join the Unite Us network can connect through uniteus.com/contact/.

About Unite Us:

Unite Us is the nation's premier technology provider for advancing social care outcomes. Our advanced product suite streamlines processes and fosters collaboration across government, healthcare, health plans, and community-based organizations to address social drivers of health by facilitating social care services, intervention programs, and Medicaid reimbursements. The first of its kind, our closed-loop referral platform now integrates more than 1M services and securely hosts the nation's largest network of non-profits committed to improving whole-person health one community at a time. Learn more at UniteUs.com and LinkedIn.

Unite Us Media Contact:
Jaquetta Gooden

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