As of November 2026, TSI's eligibility and coverage discovery service checks self-pay and eligibility-denied hospital accounts for Medicaid, Medicare, commercial and secondary coverage before a patient is billed. Accounts with coverage go back to billing inside the payer's filing limit, TSI follows each claim to payment, and patients get a bill only for what they owe.
Results vary by payer mix and client program.
- Self-pay balance$4,860
- Date of serviceSep 12
- MedicaidFound, retro to Sep 1
- Commercial secondaryNone found
- Days left to file284
- Self-pay accounts checked1,240
- With coverage96
- Returned to billing96
Got a letter or call from TSI about your own account? Go to the Consumer Support Hub or make a payment.
What a missed payer costs
Every self-pay account with hidden coverage costs you twice. The insurer never pays, and a patient who was covered gets a statement, then a call, then maybe a placement. That's a complaint waiting to happen, over a balance the patient may not owe at all.
The clock makes it worse. State Medicaid agencies must require claims within 12 months of the date of service (42 CFR 447.45(d)), and Medicare's limit is 1 calendar year (42 CFR 424.44). Medicare extends its limit in narrow cases, such as retroactive Medicare entitlement, but coverage you find in month 13 is often coverage you can't bill.
And the window for finding Medicaid after the fact is closing. For applications made on or after Jan 1, 2027, retroactive Medicaid coverage shrinks to 1 month before the application month for expansion adults and 2 months for everyone else, down from up to 3 (CMS, November 2025). Expansion adults also move to renewals every 6 months, starting with renewals scheduled on or after Jan 1, 2027, so coverage on file at one visit may be gone by the next.
What's included
Scrub before the first statement
Self-pay accounts are checked for coverage before TSI sends a statement or makes a call. Accounts with coverage go back to you with the payer details, so the patient isn't billed.
Government and commercial checks
Real-time and batch eligibility checks through EDI transactions and payer portals, in a waterfall across Medicaid, Medicare, commercial plans and indigent care programs.
Retro Medicaid and secondary coverage
Retroactive Medicaid, out-of-state Medicaid, secondary insurance and coordination-of-benefits errors, the gaps that slip past registration.
Rebilling inside the filing window
Accounts still inside the payer's timely filing limit go to the billing work queue. Claims go out electronically or on paper, with the documents the payer needs.
Follow-up to payment
About 15 days after billing, TSI checks claim status. Pended claims get the missing information; claims with nothing on file get rebilled.
Coverage screening for patients
Patients who may qualify for Medicaid or your financial assistance policy are flagged and referred to application help, in their language.
How it runs
Send the accounts
Self-pay placements, eligibility denials or an aged self-pay backlog arrive through daily files from Epic, Cerner or Meditech, or TSI works inside your system with credentials you issue.
Check coverage
Each account runs through the eligibility waterfall. Hits are verified against the date of service before anything moves.
Sort by deadline
Accounts with coverage are ranked by dollar value and days left to file, so the ones about to age out go first.
Bill and follow up
Claims are billed or returned to your billing queue, then worked to payment. Every action is noted on the account.
Send the rest forward
Accounts with no coverage move to self-pay follow-up with financial assistance screening done. Eligibility denial patterns go back to patient access as root-cause reports.
Where it fits with the other stages
Coverage discovery sits at the front of early-out self-pay: no patient statement goes out until the account has been checked. It runs again on bad debt placements, because coverage sometimes appears months later.
On the insurance side, eligibility denials from denial management get the same check: was the right payer billed, and does retro eligibility apply? Accident and workers' compensation accounts go to complex claims, since the payer there is often an auto or liability carrier. The Healthcare RCM overview shows the full chain.
What you see
Reports show accounts checked, coverage hits by payer type, dollars returned to billing, claims paid, days from discovery to payment and accounts that aged past a filing limit before discovery. That last number tells you how much earlier the check should run.
Root-cause reports group eligibility misses by where they started: a missed secondary at registration, an expired Medicaid ID, a wrong plan on file. Patient access can fix those at the source.
General information, current as of November 2026. It isn't legal advice. Rules change and differ by state, so check the sources linked here and talk to your own counsel before you act on it.
The company behind the work
Questions buyers ask
What is insurance coverage discovery?
Coverage discovery is checking accounts recorded as self-pay, or denied for eligibility, against government and commercial coverage sources to find a payer that should have been billed, then billing that payer before the filing limit.
How do hospitals find insurance coverage on self-pay accounts?
By running each self-pay account through eligibility checks across Medicaid, Medicare and commercial payers before the first patient statement, then again before write-off. TSI does this on every account it receives and returns the hits to billing with the payer details.
What does the 2027 Medicaid retroactive eligibility change mean for hospital self-pay?
For applications made on or after Jan 1, 2027, Medicaid can reach back only 1 month before the application month for expansion adults, or 2 months for others (CMS, November 2025). Uninsured visits more than a month or two before a patient applies will stay self-pay, so coverage checks and application referrals have to happen sooner.
Do you rebill the claims you find?
Yes, inside the payer's timely filing limit. TSI rebills in your system or sends the account to your billing queue, depending on how your program is set up, then follows up until the claim pays or closes.
Will patients be contacted before coverage is checked?
No. The check runs before the first statement or call, and accounts where coverage turns up go back to billing before the patient hears about the balance.
How is it priced?
It's quoted by account volume and scope. TSI doesn't publish a rate card.
See what coverage is sitting in your self-pay
Start with your eligibility denials. The Denials Economics Sprint measures one payer and one denial class against your baseline, so you can judge coverage work on your own accounts before you place a whole self-pay book.
Got a letter or call from TSI about your own account? Go to the Consumer Support Hub or make a payment.
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Paying a bill or have a question about your account? Go to the Consumer Support Hub.