As part of the prior postings, we went over the 3 main "practices" states ought to adopt in order to cost avoid and save taxpayer money. For states to possess a genuinely effective TPL plan, prompt identification of any additional coverage is needed during the time of Medicaid registration. Also, cost avoidance discovery must be instant whenever claims are made, and claims that were paid in error should be recovered swiftly. The ideal situation is one through which federal regulations and state laws merge to establish a genuinely comprehensive DRA Policy that recognizes additional health insurance coverage with speedy recovery of each claim.

A Complete TPL State Program Contains:.

The active identification of other coverage at enrollment.
The quick avoidance of the cost of claims.
The ability to recover claims paid incorrectly.

If embraced by all states, the preceding suggestions lend towards the meaningful recovery of money for state Medicaid agencies, along with the saving of money. The onus of these economic times is to do more with less money. And, as the Affordable Care Act (ACA) comes to be effective on Jan. 1, 2014, Medicaid claims are going to expand. That's why bolstering DRA-compliant legal language within all states will lend to improved cost recovery and additional savings for the healthcare of the whole country.

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Healthcare Cost Containment for States

The practice of an MCO or Medicaid charging a medical insurance provider is backwards. It's absolutely the obligation of the commercial insurance provider to make the preliminary payment, to ensure that insurance coverage claims are not delayed, which is the case when Medicaid or a Medicaid MCO does the initial billing.

It only makes sense that insurance providers should be required to handle claims quickly and make timely payments regardless of whether the claims are electronic or on paper. So long as an acceptable timeframe is utilized, an MCO or a state Medicaid agency ought to have the right to identify alternative claim processing approaches in order to maintain the integrity, and consequently the speed, of the entire process. Eventually, this implies that federal laws are complied with, timetables are developed on retrospective recoveries by state Medicaid agencies, and Medicaid funds aren't left in a state of limbo... Read More