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Automated-Health Systems
The Enlightened Choice
in Health Service Management
Eligibility/Enrollment Operations

Family

In response to increasing pressure to control costs and reorganize operations, many states are electing to streamline eligibility and enrollment operations. AHS is committed to helping states realize this vision, by working closely with our contracting partners to implement enrollment and eligibility centers. As a natural extension of our enrollment broker experience, AHS moved into providing enrollment/eligibility center contracts in 2008.

Our solutions encompass the full spectrum of operations and include systems development, customer service, document imaging and processing, mailings, and outreach.

Additional information about these contracts is provided below.




AHS’ Enrollment/Eligibility Center Contracts
Time Period Location Contracting Agency Program
2015 – Present Tennessee Health Care Finance and Administration (HCFA) Tennessee CoverKids Member Services Center
2015 – Present Tennessee Health Care Finance and Administration (HCFA) Tennessee Health Connection Member Services Center
2012 – 2016 Cook County, Illinois Cook County Health and Hospital System and Illinois Department of Healthcare and Family Services County Care Project
2011 – Present St. Louis, Missouri St. Louis Regional Health Commission Gateway to Better Health Project
2008 – 2010 Wisconsin Department of Health Services BadgerChoice Support Center Project
Tennessee CoverKids

In 2015, we were awarded a contract for CHIP eligibility determination. We implemented several technological efficiencies, including real-time web service calls to MAGI-in-the-Cloud, which we were one of the first vendors to perform. Our processes demonstrate that:

  • We can integrate the State’s hard copy policy and procedure manuals into an electronic process,
  • We incorporate processes to reduce errors,
  • We use API to pull information back into our system, and
  • We can establish real-time integration.
Tennessee Health Connection

In 2015, Tennessee awarded us an eligibility intake and assistance contract. We implemented operational protocols to effectively managed and link the complex documents related to Medicaid eligibility and route them to the State for processing. We also worked with the State to implement strategies to improve service. We used defined scripting so staff could provide more consistent responses, implemented a knowledgebase with extensive resources, which minimized the need to escalate calls. The results were improved accuracy and efficiency among our staff, and more comprehensive workflow tracking system for our client.

County Care

Cook County Health and Hospital System (CCHHS) joined with the Illinois Department of Healthcare and Family Services to pursue a Section 1115 Waiver through the Centers for Medicare and Medicaid Services. Fundamental to Affordable Care Act implementation and increasing CountyCare Membership, AHS works with CCHHS to streamline eligibility determination and processing. Through trained Eligibility Specialists, we review all applications to assess for completeness and execute an initial eligibility determination prior to submitting the completed documents to the Illinois Department of Human Services (DHS) for final review and approval.
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St. Louis Gateway to Better Health Demonstration Project

AHS is actively working with the St. Louis Regional Health Commission to implement the St. Louis Gateway to Better Health program, a pilot program in which eligible uninsured Childless Adults can be enrolled in a program through which disproportionate share hospital (DSH) funds are reallocated to pay for two tiers of care provided through participating health centers. In the first tier of care enrollees receive primary, preventive, specialty and urgent care, and in the second tier of care enrollees receive only urgent and specialty care. This program serves as a stepping stone and model for future efforts for the State in terms of its activities and programmatic changes expected under the Affordable Care Act (ACA).
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Wisconsin Enrollment Services Center

In 2008, AHS was selected to assist the State of Wisconsin in the development and implementation of an enrollment services center called the Enrollment Services Center (ESC).
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