Delinquent Premium Monitoring

Delinquent Premium Monitoring

Protect ACA Marketplace coverage during the 90-day grace period—reduce recoupment risk, prevent avoidable denials, and preserve reimbursement for high-cost cases.
Built for hospitals and health systems managing ACA Marketplace exposure.

The Hidden Risk: The 90-Day Grace Period

ACA Marketplace plans may allow a 90-day premium grace period. During that window, coverage can appear active while premiums are delinquent—creating exposure for hospitals.
    • Claims may pend or deny while the payor waits for premium resolution.
    • Previously paid claims can be recouped if coverage terminates.
    • High-cost service lines (e.g., inpatient and oncology) are most at risk.
    • Staff spend hours on eligibility re-checks, rebills, and appeals.

What Delinquent Premium Monitoring Prevents

Recoupments

Avoid repayment demands tied to retro terminations.

Unnecessary Denials

Resolve delinquency before claims age out.

Treatment Delays

Support continuity of care by stabilizing coverage.

Write-offs

Reduce preventable bad debt tied to coverage lapses.

Designed for High-Risk, High-Dollar Cases

DPM prioritizes accounts most likely to drive significant reimbursement loss if coverage lapses.

  • Marketplace primary payor (payor list varies by state).
  • Inpatient encounters where exposure escalates quickly.
  • Oncology and other high-cost episodes of care.
Operational fit: Works alongside your eligibility, authorization, and billing teams-no disruption to clinical workflows.

What Is Delinquent Premium Monitoring?

Delinquent Premium Monitoring (DPM) is a proactive program that identifies Marketplace members in premium delinquency and helps restore coverage before claims are lost.
  • Identify at-risk accounts: Daily monitoring detects Marketplace coverage in premium delinquency/grace period status.
  • Engage the patient and secure authorization: Structured outreach explains the situation, options, and next steps.
  • Restore coverage & protect reimbursement: Catch-up premium payment support (when applicable) enables claim resubmission and reduces recoupment exposure.

Outcomes That Matter to Revenue Cycle Teams

DPM is designed to reduce preventable reimbursement loss and lighten the administrative burden caused by premium delinquency.
  • Reduce recoupment risk tied to retroactive terminations.
  • Increase the percentage of high-risk accounts that resolve before
    timely filing deadlines.
  • Improve cash flow by minimizing pended claims and repeated
    rework.
  • Provide patient-friendly resolution pathways that support continuity
    of care.

How It Works

Detect Delinquency

Daily monitoring + eligibility verification to identify Marketplace accounts in the grace period.

Outreach & Explain Options

Contact the patient with a structured script to confirm status and obtain approval to proceed.

Premium Support & Tracking

When applicable, facilitate catch-up premium payment and track progress to completion.

Confirm Coverage & Protect Claims

Re-verify active coverage, then proceed with clean claim submission/resubmission and follow-through.

Operational Transparency

Clear statuses and reporting so your team always knows where each account stands.

Compliance-First

HIPAA-aware outreach, documented consent, and payor-aligned billing timelines.

Built for Scale

Daily workflows designed to support large health systems and complex payor mixes.

Other A/R Resolution Services

Insurance Billing & Follow-Up

We work within your systems to uncover/verify coverage, resubmit clean claims, and follow through until maximum reimbursement.

Early-Out Services

Patient-friendly outreach that adheres to ACA & 501(r), establishes compliant payment plans, and improves cash flow.

Legacy / AR Clean-Up

Store and work prior A/R, separate payer dollars from adjustments/patient responsibility, and resolve aged balances.

What Revenue Cycle Leaders Are Saying

Frequently Asked Questions

Is this only for Marketplace plans?

DPM focuses on ACA Marketplace premium delinquency and grace period exposure, where recoupment and pend risk are most common.

Does this replace our eligibility team?

No—DPM complements existing workflows by adding targeted monitoring, patient outreach, and resolution steps specific to delinquent premiums.

Which accounts do you prioritize?

Programs typically prioritize Marketplace primary payor accounts with high exposure—such as inpatient and oncology cases—based on your policy and payor mix.

How do we get started?

We align on target criteria, reporting cadence, workflows, and integration points—then launch daily monitoring and outreach.

Stop Losing Marketplace Revenue to Premium Delinquency

Let’s build a DPM workflow tailored to your payor mix, service lines, and operational structure.