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HPE Eligibility Software

Fast track HPE Medicaid eligibility with CoverMe’s automated Hospital Presumptive Eligibility program. With CoverMe, HPE determinations are provided in real-time, every time.

Compliance Solution for Hospital Presumptive Eligibility Application

Mockup of a happy customer face surrounded by related details that are partially checked, along with a meter reading indicating eligibility

CoverMe can effectively identify patients who will qualify for Medicaid in near real-time through the Hospital Presumptive Eligibility (HPE) program as allowed by the Affordable Care Act.

Medicaid presumptive eligibility allows immediate access to health coverage for eligible individuals. HPE improves individuals' access to Medicaid and necessary service options by providing another channel to apply for healthcare coverage.

HPE ensures the qualified hospitals will be reimbursed for healthcare services provided, just as if the person was enrolled in standard Medicaid at the time of treatment.

We have all the necessary data compiled and scored to help you make accurate PE determinations. Our software can deliver the completed applications right to the user's desktop within seconds.


The Key Aspects

CoverMe's automation of Hospital Presumptive Eligibility takes the guesswork out of the complicated manual Medicaid application process - patients get covered, and providers get paid.


Using our HPE program support, CoverMe provides hospital presumptive eligibility compliance solutions and guarantees that providers will meet state policies and program compliance requirements without fail. Don’t be deterred - with CoverMe, timeliness and accuracy are assured.


CoverMe's HPE program support replaces the manual processes routinely used by onsite Medicaid vendors, saving providers time and money.

Immediate Coverage

With Hospital Presumptive Eligibility (HPE), qualified individual applicants or families can be temporarily enrolled in Medicaid immediately if it appears they are presumptively eligible in one of the HPE coverage groups (Children under age 19, former foster care children, pregnant women, parents, or caretakers).


CoverMe's HPE software is a preferred choice for healthcare providers looking for the fastest and most reliable path to complete a patient's Medicaid eligibility determination.

  • Replaces traditional Medicaid eligibility vendors and speeds up your process.
  • Provides a channel to apply for coverage and improves access to Medicaid.
  • Ensures providers an appropriate reimbursement for healthcare services
  • Assists in the screening process and supports providers in making informed recommendations.

Video Insights

Want to learn more about CoverMe's HPE support? Take a look at this video!

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How can CoverMe assist providers in completing the HPE determination of a patient?

CoverMe offers real-time identification of patients who will be eligible for Medicaid enrolment. Providers can also make informed enrollment recommendations with CoverMe's assistance during the screening process.

How long does it take for the system to verify eligibility, or is it instant?
CoverMe offers a real-time eligibility verification solution. Thus, the system allows the provider to identify patients eligible for Medicaid almost instantly.
How does CoverMe help meet HPE compliance requirements?
CoverMe assesses the eligibility of a patient for Medicaid and auto-fills the applications. This replaces the manual processes and also ensures the accuracy of data entered. This enables providers to meet the state standards for accuracy and comply with the HPE program performance metrics.
Are state-specific HPE compliance and eligibility requirements inbuilt into the system?
Yes. CoverMe is a customizable solution. Hence state-specific eligibility rules and conditions can be configured in the system. To know more, schedule a demo with us.