Application completeness
All required fields and supporting documents present — identity, residency, citizenship, income, assets, and resource verification — or the packet does not release.
The most rigorous Medicaid conversion engine a skilled nursing facility can deploy.
Our AI-native service ingests five years of financial records, reconstructs the spend-down and look-back timeline, assembles a state-complete application packet, and answers verification requests — all reviewed by a certified eligibility specialist before submission. We sell the approved determination, not a portal.
Every element of 42 CFR §435.907 and state-specific rulesFive-year financial record reconstructionDHSMV · USCG · UCC · judgment lien searchesCertified eligibility specialist review on every file5-business-day SLA
Why applications fail
A single missing document can delay approval by months — or trigger a denial.
For a skilled nursing facility, every 'Medicaid pending' resident represents $18,000–$25,000 of at-risk accounts receivable. The state has up to 45 days to decide, but missing paperwork is the dominant failure mode — during the Medicaid unwinding, roughly 69% of disenrollments were procedural, not substantive.
Most facilities rely on an overworked business-office manager to chase families for bank statements, reconstruct five years of financial history, and navigate state-specific asset and income tests — all while juggling a hundred other tasks. That is exactly where gaps hide.
Our conversion engine exists to close that gap with a single, exhaustive standard applied identically to every file.
69%
of Medicaid disenrollments were procedural (paperwork), not ineligibility
The benchmark
Measured against the letter of federal and state Medicaid rules — subsection by subsection.
We do not summarize the law and hope. Every application packet is scored against a versioned rule pack tied to the exact text of 42 CFR §435.907 and the relevant state Medicaid manual. These are the provisions each packet is held to.
Five-year look-back reconstruction
Every financial transaction over the past five years is categorized and mapped to the state's asset/income test, with any gaps flagged.
Verification response readiness
All common verification requests (bank statements, life insurance, property records) are pre-answered and attached, reducing back-and-forth.
State rule mapping
The packet is built against the exact asset and income limits of the resident's state, including spousal impoverishment protections where applicable.
Timely filing
The application is verified to be filed within the state's timely filing window, with a deterministic calendar computed from admission date.
Specialist review
A certified eligibility specialist reviews every determination and owns the caseworker relationship; legal strategy is routed to a partner elder-law attorney.
How a conversion is built
Intake to specialist release, with deterministic gates the AI cannot overrule.
AI extracts and drafts. Deterministic rules — running as code, outside the model — decide what is complete. A certified eligibility specialist signs every release. That order is never reversed.
01
Pending A/R Scan
Upload the resident's ledger and basic info. We return a free completeness read: which documents and verifications you already have, and which are missing.
02
Financial record ingestion
As your authorized clerical agent, we ingest five years of bank statements, tax returns, life insurance policies, property deeds, and other records — extracting and categorizing every transaction.
03
Timeline reconstruction
The look-back and spend-down timeline is reconstructed from the extracted data, mapped to the state's asset/income test, and any potential transfer penalties are flagged.
04
Deterministic completeness gates
All required fields are checked against the state's application form; the five-year look-back is verified; verification responses are pre-drafted; any missing element blocks release.
05
Specialist review & submission
A certified eligibility specialist reviews the file, signs the determination, and submits the application to the state caseworker. High-value or complex cases route to a partner elder-law attorney first.
06
Approval & revenue recovery
You receive the approved determination and the retroactive Medicaid revenue. We track the file through to payment, with ongoing redetermination monitoring available.
The bar we hold
Rigor you can measure.
100%
Specialist-reviewed
No packet ships without a certified eligibility specialist's signature.
5 days
Standard SLA
From complete intake to submitted application.
<1%
Procedural denial target
Tracked against a gold-standard packet library.
50+
State rulebooks mapped
Every state's Medicaid manual versioned and maintained.
Why our conversion engine
Built to be the most thorough option a facility has.
Documentation-complete, by design
The deliverable is completeness itself — every required document and verification accounted for or explicitly exception-coded. Nothing is left implicit.
Deterministic, not vibes
The gates that decide completeness are code, not a model's opinion. A drafting error cannot slip past a statutory requirement.
In its lane, on purpose
We prepare documentation and run verifications as your clerical agent. We never give legal advice or engage in Medicaid planning; that stays with a partner elder-law attorney.
Engagement
Flat fee per approved application, plus a share of retroactive Medicaid revenue. No hourly billing, ever.
Simple, predictable, and aligned with the outcome — not a cut of any recovery.
- A free Pending A/R Scan before you commit — see exactly what is missing.
- One flat fee per approved application; disclosed pass-through verification costs.
- A success fee tied to retroactive Medicaid revenue recovered — only paid when you get paid.
- Optional Redetermination Monitoring Add-on for ongoing eligibility maintenance.
FAQ
Questions, answered precisely.
Is this a law firm?
No. Our service provides documentation-completeness and application assistance. It is not a law firm, does not provide legal advice, and does not represent you in any legal matter. Attorney review is available and recommended for complex cases involving Medicaid planning.
Do you contact the resident or family?
Only to request documents as your authorized clerical agent. We never provide legal advice to the resident or family. The facility remains the primary point of contact.
What makes a packet 'complete'?
Completeness is defined by federal and state rules: all required fields and supporting documents present, the five-year look-back reconstructed, verification responses pre-drafted, and the application filed within the timely filing window. Deterministic gates enforce each one before release.
How fast is it?
The standard SLA is five business days from complete intake to submitted application. The free Pending A/R Scan is returned much sooner and tells you exactly what is still needed.
How are you priced?
A flat fee per approved application, plus a success fee on retroactive Medicaid revenue recovered. No hourly billing and no percentage of any ongoing revenue.
See what's missing before it costs you another month of pending A/R.
Start with a free Pending A/R Scan. Send your resident's ledger and basic info and we'll return a completeness read against every applicable federal and state rule.
Documentation-completeness service · not legal advice · the facility remains the applicant.