Rural hospitals have stopped helping patients enroll in Medicaid. That means eligible, healthier members your plan should already have are sitting unenrolled — shrinking your risk pool and your margins. HRN's enrollment intelligence finds them.
Schedule a Market Intelligence BriefingRural hospitals have stopped helping non-presumptive patients apply for Medicaid. That means fewer enrolled members and less capitation revenue for your plan.
Medical cost trends have outpaced capitation rates for two consecutive years. Medicaid MLR hit 91% in 2024. 35-60% of denied claims are never resubmitted — but 57% of those appealed get overturned.
When payment patterns drive rural hospitals to disengage — restricting services, reducing enrollment assistance — your network adequacy metrics suffer and CMS is now watching.
Rural providers have stopped facilitating Medicaid applications for non-presumptive patients. HRN's eligibility intelligence — built on 155.6M claims — identifies patients who qualify but haven't enrolled. More members = more capitation revenue + healthier risk pool.
High denial rates that get overturned on appeal cost you twice: once in admin processing, again in regulatory exposure. HRN's 8-dimension claims analysis identifies patterns costing you money before CMS reporting makes them visible.
When payment rates drive rural hospitals to disengage, your network adequacy metrics suffer. HRN quantifies the link between payment patterns and provider engagement, giving you intelligence to act before CMS does.
155.6M Medicaid claims, 4 federal databases (CMS Coverage Database, ICD-10-CM, NPI Registry, PubMed)
Fee schedules, MCO contract rules, legislative changes
Claims analysis patterns, denial trends, provider engagement signals
Intelligence neither hospitals nor MCOs can generate alone.
Our market intelligence briefing shows you where your biggest opportunities are—and how to act before CMS does.
Schedule a Market Intelligence BriefingNo cost. No commitment. We show you the data first.