STATES CAN START MEDICAID ELIGIBILITY REDETERMINATIONS APRIL 1, 2023

 

Over the last three years, the Coronavirus public health emergency was extended numerous times. The PHE and the Families First Coronavirus Response Act adjusted Medicaid eligibility, and consequently, Medicaid enrollment increased dramatically during the course of the pandemic. Between February 2020 and July 2022, 82 million people enrolled in the Medicaid program, but millions are expected to lose coverage in 2023.

Recently, Congress released H.R. 2617 and within the $1.7 trillion bill was a requirement for states to start Medicaid eligibility redeterminations by April 1. States have been expecting eligibility redeterminations, but up until this point, it was not clear when they would occur because of the PHE extensions.

Due to the April deadline, they will need to review their Medicaid budgets as federal funding decreases and maintenance of eligibility requirements (MOE) expire. States expect the eligibility redeterminations to take at least a year to complete. During that time, it will be critical for states to communicate the change and updated eligibility statuses to program recipients.

In the course of the pandemic, Congress passed the FFCRA to expand Medicaid coverage and deliver additional fiscal aid to states by increasing the federal medical assistance percentage (FMAP) by 6.2 percent. Under the legislation, states were restricted from changing eligibility or removing members from the program. In recent months, states have requested a 120-day notice to prepare for the end of the PHE, but H.R. 2617 only allows for 3 months.

Along with eligibility redeterminations, the bill also features a gradual phase-down of the 6.2 percent FMAP over the next year. Rather than an instant reduction, the FMAP will decrease to 5 percent between April and June and slowly drop to 1.5 percent by the end of December.

States will need to generate monthly reports and make various efforts to correspond with plan members before they disenroll them to qualify for the FMAP step-down. For instance, states can not disenroll a member because their mail was returned. Plans will need to follow up with beneficiaries using other methods, such as email. These efforts will help to reduce the number of beneficiaries that lose coverage.

According to Medicaid.gov, this will be the "single largest health coverage transition event since the first open enrollment period of the Affordable Care Act." DHHS released a report in August predicting that approximately 15 million people would lose coverage based on historical patterns of coverage loss.

Now that states have a deadline to redetermine Medicaid eligibility, coordinating benefits to ensure eligible beneficiaries continue receiving coverage will be crucial. Some members will be eligible for additional benefits. Others may enroll in employer-sponsored healthcare or find coverage on the ACA exchange. While eligibility redeterminations will be a challenging task for Medicaid plans, it will also present an opportunity to ensure that vulnerable populations receive benefits and that program resources are preserved.

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OCTOBER MEDICAID NEWS ROUNDUP

 

Syrtis Solutions delivers a monthly Medicaid news recap to help you stay up-to-date. The monthly roundup highlights developments, research, and legislation that pertains to Medicaid program integrity, cost avoidance, coordination of benefits, third party liability, improper payments, fraud, waste, and abuse. Below is a list of last month's important Medicaid news.

Click here to read the news.

SEPTEMBER MEDICAID NEWS

Syrtis Solutions distributes a monthly Medicaid news roundup to help you stay informed. The monthly roundup concentrates on developments, research, and legislation that relates to Medicaid integrity, cost avoidance, coordination of benefits, third party liability, improper payments, fraud, waste, and abuse. Below is a list of last month's significant Medicaid developments.

Continue reading here. 

NYRx PHARMACY BENEFIT CARVE OUT

 

Changes in how pharmacy benefits are supplied under New York's Medicaid program are coming. Earlier this year, the state reported that to lower prescription drug costs, it would carve out its Medicaid pharmacy benefits and transition to a fee for service delivery model. On April 1, 2023, Medicaid members will start receiving their pharmacy benefits under the state's new delivery model, NYRx.

New York's carve out strategy is designed to decrease pharmaceutical drug costs by consolidating the state's purchasing power. In addition to lowering costs, the carve out is also geared to improve access to care and reduce restrictions by introducing a single drug formulary.

The decision to carve out, however, has not gone unnoticed. Over the past year, there has been a growing amount of criticism directed at the state's decision. The advocacy organization, Save NY's Safety Net, wrote the state's governor earlier this month and requested that she reverse the decision. They are concerned over its impact on the delivery of healthcare to the state's most vulnerable populations. They also warned the governor that the carve out would negatively affect the Medicaid program's provider network. According to the coalition, "many existing facilities will be forced to close completely, and hundreds of frontline community healthcare workers will lose their jobs."

Advocates of the carve out, like New York state Assemblyman John McDonald, disagree with the advocacy groups. He strongly believes that the shift will help more program recipients than it hurts.

According to the New York State Department of Health, "moving all Medicaid consumers under the FFS Pharmacy Program allows for a single, uniform list of covered drugs and standardized, consistent rules and regulations. Thus, New York State is able to offer an improved, simplified process for Medicaid consumers to get the medicines and supplies they need."

Each year prescription drug spend accounts for a larger percentage of state budgets. To reduce these costs, some states like New York have chosen to transition to fee for service models and carve out pharmacy benefits. While this is one approach to try and reduce costs, states should also identify opportunities to improve efficiency and cost avoid in their Medicaid plans.

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AUGUST MEDICAID NEWS RECAP

 

Syrtis Solutions delivers a monthly Medicaid news recap to help you stay up-to-date. The monthly recap focuses on developments, analysis, and legislation that relates to Medicaid integrity, cost avoidance, coordination of benefits, improper payments, fraud, waste, and abuse. Here is a recap of last month's noteworthy Medicaid news.

Click here to see the news. 

MEDICAID NEWS IN JULY

Syrtis Solutions sends out a monthly Medicaid news roundup to help you stay informed. The monthly roundup highlights developments, analysis, and legislation that pertains to Medicaid program integrity, cost avoidance, coordination of benefits, third party liability, improper payments, fraud, waste, and abuse. Below is a summary of last month's significant Medicaid news.

See the news. 

JUNE MEDICAID RECAP

Syrtis Solutions sends out a monthly Medicaid news roundup to help you stay informed. The monthly recap focuses on developments, analysis, and legislation that pertains to Medicaid integrity, cost avoidance, coordination of benefits, third party liability, improper payments, fraud, waste, and abuse. Here is a summary of last month's important Medicaid news.

See the news here. 

COST AVOIDANCE MAKES MORE SENSE

 

Medicaid has become an integral safety net program that gives access to health care for millions of Americans. Payment for this health care is either delegated to Medicaid or other third party insurance coverage. In 2012, 7.6 million people on Medicaid had other private health insurance coverage, and 10.6 million had other public coverage. Medicaid is positioned as the "payer of last resort": if the Medicaid beneficiary has supplemental insurance, that third party insurance is liable for primary payment. The additional insurance coverage is commonly referred to as third party liability (TPL) and creates cost savings for Medicaid by rerouting payment to other forms of insurance before Medicaid must pay. Unfortunately, Medicaid is losing billions of dollars a year because plans are unable to identify TPL.

Identifying TPL is a very complex undertaking because of siloed data, antiquated technologies, and network latency. Medicaid plans attempt to ascertain liable third parties by making use of data matching in several health care data sources. However, they are rarely updated and create several barriers. The challenge of finding accurate TPL frustrates those on the frontlines and creates a stressful, time-consuming search that only occasionally generates results. Claims may already be in progress or completed when TPL is identified. In that case, Medicaid scrambles to get reimbursed for the money they paid for the health care provided when it should have been delegated to a third party for payment. This scrambling is called "pay and chase": Medicaid chases the payment from the third party. Once Medicaid plans identify the liable third party payer, they rarely receive a full refund from the amount originally distributed, and it's costing the program billions of dollars in waste. Typically, Medicaid only recovers a mere 17% of funds used for payment through the "pay and chase" method. "Pay and chase" is clearly ineffective and inefficient. Searching for TPL, identifying the correct distributor, and replacing funds all take additional time and increased administrative costs.

The obvious solution for all parties involved is to identify TPL at the start of the coordination of benefits. Providers are paid faster, administrators have ease identifying the accurate payment provider, and Medicaid enrollees have their services covered. Finding solutions for prospective TPL identification should be made a priority, even more so for a program with such a wide scope and reach as Medicaid. Medicaid plans agree that cost avoidance makes more sense, but until now, the ability to execute it effectively has not been widely available.

Syrtis Solutions realized that Medicaid plans needed a solution to identify active OHI coverage so that claims could be adjudicated correctly. So, in 2010, they launched ProTPL, a real-time point of sale cost avoidance service for the payer of last resort market. ProTPL delivers powerful and accurate eligibility data that can be acted upon. The solution enables plans to cost avoid Rx and medical claims and the associated costs of recovery. Moreover, the coverage identified by ProTPL can not be found by other vendors. Syrtis Solutions is able to accomplish this by checking claims against the nation's largest and most complete active healthcare coverage information database. Health plans that implement ProTPL see an average 25% increase in OHI discovery. This means Syrtis' customers get the best and latest eligibility responses when they need them.

Identifying primary commercial insurance coverage is incredibly difficult for payers of last resort. Due to the complexity of COB, the near-constant change in the Medicaid population, and bad quality eligibility data, health plans depend heavily on retrospective identification and recovery. Unfortunately, this is costing Medicaid billions of dollars in waste. To protect program resources and ensure that vulnerable populations receive the care they need, plan administrators should look to true TPL technology solutions for further efficiency and cost avoidance opportunities.

Find out more here. 

FFCRA AND PHE MEDICAID ELIGIBILITY REDETERMINATIONS

On January 31, 2020, the Department of Health and Human Services declared the Coronavirus a public health emergency. Since then, the Public Health Emergency (PHE) has been renewed nine times, but it is set to expire this August unless it is extended again. Its expiration will have a major impact on Medicaid, when one takes into consideration that millions of beneficiaries will lose the coverage that the PHE and corresponding legislation provided.

Soon after the PHE was declared, Congress passed the Families First Coronavirus Response Act (FFCRA). The legislation served to provide relief during the pandemic by expanding Medicaid to prevent coverage losses for vulnerable populations while simultaneously giving fiscal relief to states. The FFCRA was able to accomplish this by raising the federal medical assistance percentage (FMAP) by 6.2 percent. Additionally, the FFCRA altered the maintenance of eligibility (MOE) requirements by prohibiting states from changing eligibility or removing members from the program, and changed enrollment processes until the end of the pandemic.

Due to the changed Medicaid eligibility criteria, enrollment in the Medicaid program surged during the pandemic. A report by KFF estimated that program enrollment grew by twenty-five percent or 22.2 million enrollees between FY 2019 and FY 2022. Out of those enrolled, MOE enrollment growth represented 18.7 million new enrollees.

With the end of the PHE approaching, states will need to review their Medicaid budgets considering that they will no longer receive the FFCRA's increased funding. Additionally, the MOE requirements will expire, and states will need to begin eligibility redeterminations. As a result, KFF estimates that anywhere between 5.3 million and 14.2 million enrollees could lose coverage.

According to Medicaid.gov, this will be the "single largest health coverage transition event since the first open enrollment period of the Affordable Care Act."

Coordinating benefits to ensure eligible beneficiaries continue receiving coverage during the transition will be critical. CMS has published guidance to assist states with eligibility redeterminations, transitions between coverage programs, and resuming normal eligibility and enrollment operations. According to the guidance, states will have 12 to 14 months to perform redeterminations. DHHS will give a 60-day notice on when the PHE will end to help states prepare.

Considering the growth in Medicaid enrollment because of the FFCRA and the upcoming expiration of provisions, it will be interesting to see how many individuals will remain eligible to receive the Medicaid program's vital health care benefits. In some instances, the circumstances for some individuals will have improved, so they will no longer require assistance. Alternatively, some beneficiaries may be eligible for additional benefits. Eligibility redeterminations will certainly be a challenging task for Medicaid plans; however, it will be an opportunity to ensure that the most vulnerable populations are receiving benefits and that program resources are being used responsibly.

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MAY MEDICAID ROUNDUP

Syrtis Solutions publishes a monthly Medicaid news recap to help you stay informed. The monthly summary focuses on developments, analysis, and legislation that pertains to Medicaid program integrity, cost avoidance, coordination of benefits, third party liability, improper payments, fraud, waste, and abuse. Here is a summary of last month's important Medicaid news.

Read more here. 

APRIL MEDICAID ROUNDUP

Syrtis Solutions sends out a monthly Medicaid news recap to help you stay informed. The monthly recap highlights developments, research, and legislation that relates to Medicaid program integrity, cost avoidance, coordination of benefits, third party liability, improper payments, fraud, waste, and abuse. Below is a summary of last month's significant Medicaid news.

Read the news summary. 

OUTDATED SYSTEMS AND LOW-QUALITY DATA ARE COSTING MEDICAID BILLIONS

 

The government doled out nearly $100 billion in "improper" Medicaid payments in 2021-- accounting for about one-fifth of all Medicaid payments, according to estimates.

The figure represents Washington's current accounting of payments that did not meet the numerous requirements for the Medicaid program, which the federal government manages in conjunction with the states and allows millions of low-income people access to healthcare.

The numbers were also high in 2020, with about $86.5 billion in Medicaid payments deemed improper, or just over 21%.

Medicaid provides healthcare coverage to nearly 80 million people, more than 30 million of which are children. The number of adults enrolled in the program has greatly risen recently, partly because of the pandemic, as well as Medicaid expansion under the Affordable Care Act (ACA).

Improper payments are not synonymous with fraud and abuse, according to analysts and the federal agency that oversees Medicaid and generates the data. "Instead, improper payments are payments that did not meet statutory, regulatory, administrative, or other legally applicable requirements and may be overpayments or underpayments," the Centers for Medicare and Medicaid Services (CMS) says. Improper payments also include payments that may have been valid but where there was not enough data on file at the time of the review to verify they were made properly, according to CMS.

The stunning stats are evidence of a swelling Medicaid regime with obsolete and largely varied state systems for tracking data. Furthermore, federal officials have been using updated criteria to review Medicaid eligibility over the last few years, making it challenging to compare current rates with those of years past.

The figures have nevertheless attracted scrutiny from government watchdogs looking to ensure that billions in tax dollars are being paid and tracked correctly. In February, the inspector general for the U.S. Department of Health and Human Services published a report outlining its past audits to help CMS "in achieving greater efficiencies in its operation of the Medicaid program."

The inspector general's review sampled four states (New York, California, Colorado, and Kentucky) and "found that these States did not always determine Medicaid eligibility" for both newly eligible individuals and those who qualify under old rules "in accordance with Federal and State requirements."

CMS reported actual monetary losses-- cases where officials identified a payment was, actually, erroneously made, were about $11 billion last year. Though it represents a small fraction of total Medicaid spending, it remains a cause for concern, experts say.

"Instead of twisting the [audit] results to fit an erroneous narrative of rampant beneficiary fraud, we should acknowledge that mistakes will be made and act to reduce identified errors collaboratively," Kelly Whitener, a professor at Georgetown University, wrote in 2019.

Missing documentation is another primary factor driving up improper payment rates, according to CMS's data. In 2021, 89% of improper payments were caused by insufficient documentation, representing more than $87 billion in payments. Of those, over half were linked to eligibility determination.

According to CMS reports, the Medicaid overpayment rate swelled from 9% in 2018 to 21% in 2020. In the 2020 report, CMS said that year's figures couldn't be compared to those before 2019, though, because that's when it implemented a key change in the eligibility rules it uses to audit payments.

The Payment Error Rate Measurement audit program (PERM) is what produces improper payment rates each year and operates on a three-year cycle. "CMS paused PERM eligibility reviews from 2015 to 2018, as states were implementing new rules under the Affordable Care Act for determining eligibility for many beneficiaries," the agency said.

Jessica Schubel, a senior policy analyst at the Center on Budget and Policy Priorities, said "most eligibility errors reflect paperwork problems or other procedural mistakes that can easily occur when eligible people enroll." For example, an incorrect code (where a state inadvertently assigns the parent eligibility code to an eligible child) is considered an improper payment. In another example, a caseworker could fail to determine if the enrollee has primary commercial coverage.

In general, the data and documentation problems within the Medicaid system mean that determining the actual fraud rate is challenging. "I don't know anyone who knows the answer. I certainly don't," Andy Schneider, a professor at Georgetown University said when asked what he believed the actual fraud levels were. All he knows, he said, is that "the rate of fraud varies from state to state" and "most of the state and federal government's losses from Medicaid fraud are attributable to providers or managed care plans, who receive Medicaid payments, and not to applicants or beneficiaries, who don't." "Of the 77 million Medicaid beneficiaries as of November 2021, 33 million, or over 40%, were children," he said. "Few of whom would even know what fraud was, much less commit it."

Medicaid improper payments have risen throughout the years and while PERM brings the problem into scope, it does nothing to reduce them. These payments often stem from fraud and abuse but the vast majority are actually a result of eligibility errors from antiquated systems and low-quality data. To reduce improper payments states and Medicaid plans must turn to data solutions to improve the coordination of benefits and identification of third party liability.

Click this link to learn more. 

MARCH MEDICAID NEWS

 

Syrtis Solutions publishes a monthly Medicaid news summary to help you stay up-to-date. The monthly roundup concentrates on developments, analysis, and legislation that relates to Medicaid program integrity, cost avoidance, coordination of benefits, third party liability, improper payments, fraud, waste, and abuse. Below is a list of last month's important Medicaid news.

Read March's news. 

FEBRUARY MEDICAID RECAP

 

Syrtis Solutions issues a monthly Medicaid news summary to help you stay up-to-date. The monthly summary focuses on developments, research, and legislation that relates to Medicaid integrity, cost avoidance, coordination of benefits, third party liability, improper payments, fraud, waste, and abuse. Below is a list of last month's important Medicaid developments.

See the news. 

MEDICAID IS LOSING BILLIONS FROM ELIGIBILITY ERRORS

Since its passage in 1965, the Medicaid has grown to become the single largest payer for health care in the United States, costing $671.2 billion in 2020. Because of surges in enrollment from the pandemic and the present administration's priorities, spending is only projected to increase. Considering that Medicaid improper payments now make up more than twenty percent of federal Medicaid expenditures, this is a cause for concern. Improper payments are threatening the program's solvency and sustainability.

In FY 2021 alone, Medicaid's estimated improper payments amounted to an enormous $98.72 billion. A typical misunderstanding is that this waste originates from fraud or abuse when in fact, it is overwhelmingly due to eligibility errors. According to the Foundation for Government Accountability (FGA), 80 percent of improper payments stem from individuals receiving benefits who are not eligible for the program. This problem has become such an issue that, "improper payment rates have reached as high as nearly 50 cents for every Medicaid dollar spent in some states."

In a recent interview, Hayden Dublios, Deputy Research Director for the FGA, stated "What's interesting is that most of the improper payment rates are pre-COVID, so we may not know how high the number really is yet."

The FGA's study investigated the improper payment problem by sampling a number of states and compared their improper payment rates with the national average using data from CMS and other sources. What they found was concerning. Ohio's improper payments rate was 44 percent, and 98 percent of those payments were because of eligibility errors. Illinois had an improper payment rate of 37 percent, and ineligible enrollees accounted for 95 percent of it. Kansas had an improper payment rate of 28 percent and 99 percent of its improper payments also stemmed from eligibility errors.

In March of 2020, The Families First Coronavirus Response Act increased Medicaid funding by 6.2 percent to support states during the pandemic. Under H.R. 6201, states were prohibited from altering eligibility, adjusting enrollment processes, or disenrolling members from the program, despite eligibility, until the end of the pandemic. When the FGA reviewed data from 17 states, they identified that about 90 percent of new enrollees from during the pandemic are no longer eligible for Medicaid. In fact, by the end of 2021, 17 million enrollees were ineligible. They advise that states remove ineligible enrollees to lower costs and that states should not fear a clawback due to the guidance published by CMS.

MEDICAID CAN COST AVOID AND SAVE

To decrease eligibility errors and improper payments, States must look to improving program efficiency with cost avoidance opportunities. Ultimately, eligibility errors arise from bad quality data and outdated TPL processes, not intentional fraud and abuse. Payers of last resort struggle to identify primary coverage on pharmacy and medical claims. The majority of the data they have access to is not current, available, complete, or accurate. Because of this, plans have no choice but to pay claims in error and seek reimbursement once other health insurance (OHI) is found. Unfortunately, the actual monies recovered remain around twenty cents on the dollar.

Syrtis Solutions recognized that Medicaid plans needed a way to detect active OHI coverage so that claims could be adjudicated correctly. So, in 2010, they launched ProTPL, a real-time point of sale cost avoidance solution for the payer of last resort market. ProTPL provides powerful and accurate eligibility data that can be acted upon. The solution gives payers of last resort the ability to cost avoid pharmacy and medical claims and the associated costs of recovery. In addition, the coverage identified by ProTPL can not be found by other vendors. Syrtis Solutions is able to do this by checking claims against the nation's largest and most complete active healthcare coverage information database. Customers who adopt the tool see an average 25% increase in OHI discovery. This means Syrtis' customers get the best and latest eligibility responses when they need them.

Surges in Medicaid enrollment over the past two years have increased the chances for waste in the program. This is a problem because Medicaid is currently losing billions every year in improper payments. Right now, one of the most significant opportunities for reducing costs lies within the coordination of benefits. Plan administrators should look to TPL technology solutions for further efficiency and cost avoidance opportunities.

Read more here. 

JANUARY MEDICAID ROUNDUP

Syrtis Solutions publishes a monthly Medicaid news roundup to help you stay informed. The monthly summary concentrates on developments, research, and legislation that pertains to Medicaid program integrity, cost avoidance, coordination of benefits, third party liability, improper payments, fraud, waste, and abuse. Here is a summary of last month's significant Medicaid news.

Read the news here. 

THIRD PARTY LIABILITY REQUIREMENTS IN THE MEDICAID PROGRAM

The Social Security Act, signed into law by President Franklin Roosevelt in 1934, stipulates in the statute § 1902( a)( 25) of the law "... that the State or local agency administering such plan will take all reasonable measures to ascertain the legal liability of third parties ... to pay for care and services" delivered to Medicaid recipients. Essentially, it means that Medicaid becomes the payer of last resort, a term also known as third party liability, or the coordination of benefits. In other words, Medicaid pays last, and if a Medicaid member holds other coverage, such as insurance from an employer, that insurer pays first, and then Medicaid pays any remaining costs.

As much as 10 percent of the Medicaid members across the nation hold additional insurance besides Medicaid, which is considered TPL. Types of TPL include employee insurance, Workers' Compensation, Medicare, COBRA insurance from past employment, casualty insurance, dental insurance, eye insurance, and insurance to cover pharmaceutical costs.

The Deficit Reduction Act passed by Congress in 2005 stipulates in Section 6035 that states are directed to pass laws that force health insurance companies to give the state health insurance premium data involving people who are eligible for Medicaid assistance. Specifics of the DRA include:

• Health insurance companies must hand enrollment information over to Medicaid, or its agent, so member benefits can be coordinated.
• This information is to be used to identify supplementary health insurance coverage so that improper payments are not made and payments made in error are recovered.
• Payments are required to be made as long as the claim is submitted within three years after the medical service was provided.
• Claims cannot be denied as long as the state started action on the claim within six years after the state submitted the claim.

Specifications must be made that health insurance consists of other entities that are by statute, agreement, or contract, legally responsible for paying a claim of a healthcare service; pharmacy benefit managers; managed care organizations; group health plans; and self-insured plans.

IDENTIFYING THIRD PARTY LIABILITY IN MEDICAID

Determining primary health insurance coverage of Medicaid beneficiaries can be achieved by a state through one of three different approaches and still allow the state to comply with TPL criteria, under federal law. The problem is that if only one approach is implemented by the state, savings and recovery are not at their greatest possible amount. The highest level of savings consists of processing at all three of the following points in the process by the state. Here are those processes:

Applicants enrolling in the program are asked about other insurance coverage.

The issue is that some enrollees assume they will be disqualified from Medicaid, so this information is withheld. And, since adding Medicaid coverage might also imply an employment change in which employer insurance coverage is lost, this disclosure might be immaterial soon after the applicant's enrollment.

The state looks for TPL coverage in order to avoid extra cost.

Medicaid eligibility names are cross-referenced with names enrolled in state and national health insurance companies in order to detect primary insurers before the submission of Medicaid claims. But, this practice becomes impossible unless state rules require the timely delivery of insurance data when a state also requires the prompt payment of insurance claims. Additionally, a number of medical services, like those dealing with a pregnancy, must be paid at the time that they are claimed, according to federal law. That means that pregnancy claims have to be paid immediately before recovery can be made from responsible insurers.

Improper payments are recovered.

The third part of a comprehensive TPL plan involves Medicaid's payment, which occurs one of two ways. Medicaid can offset the service provider during the next payment issued for the amount that was overpaid. This is called "provider disallowances." Or, Medicaid receives the overpayment from the correct insurance carrier. This is called commercial insurance direct billings. Strong state policies are required for this third step in a TPL plan to function, since without it, the state can receive denials from insurance companies. The bottom line is that when payment errors are cost avoided, time is not wasted in pay and chase activities.

WHAT AN EFFECTIVE TPL PLAN NEEDS TO INCLUDE

So, in order to gain an efficient TPL plan, immediate and effective discovery of additional coverage is needed at Medicaid enrollment. Also, cost avoidance discovery must take on immediacy when claims are made and past errors need to be resolved quickly. What works best is when the federal directives and state laws mesh to form a truly thorough DRA policy that realizes other health insurance coverage with quick recovery of each claim.

ProTPL offers a solution that provides this critical information in real-time, at the point of sale.

Read more.

MEDICAID 2021 - A YEAR IN REVIEW

 

Syrtis Solutions distributes a year-end Medicaid review to help you stay informed. The yearly roundup concentrates on developments, analysis, and legislation that pertains to Medicaid program integrity, cost avoidance, coordination of benefits, third party liability, improper payments, fraud, waste, and abuse. Below is a list of last year's important Medicaid developments.

Read here. 

MEDICAID NEWS IN DECEMBER

Syrtis Solutions publishes a monthly Medicaid news roundup to help you stay up-to-date. The monthly recap focuses on developments, analysis, and legislation that relates to Medicaid integrity, cost avoidance, coordination of benefits, third party liability, improper payments, fraud, waste, and abuse. Here is a list of last month's important Medicaid news.

Click here to read.