Medicaid COB sits at the intersection of fiscal responsibility and patient protection. As states face historic funding challenges, efficiency is no longer optional—it’s essential. The Medicare Rights Center recently reported that multiple states are already cutting back provider rates and optional services in anticipation of substantial federal reductions, projected to total $1 trillion over the next decade.
Such cuts pose real risks to access and quality of care. But benefit reductions are not the only—or even the best—solution. State Medicaid agencies and MCOs can achieve major savings by closing administrative gaps and improving payment accuracy. The key is ensuring Medicaid pays only when truly responsible, which hinges on more effective coordination of benefits and third-party liability management.
Syrtis Solutions’ article, Improper Payments: Medicaid’s Billion-Dollar Problem, underscores that billions in claims each year are misallocated because Medicaid lacks timely visibility into other coverage. The consequence is an inefficient “pay and chase” cycle that rarely recovers its full cost.
By contrast, modern technology now allows for real-time primary coverage identification within Medicaid COB. ProTPL, Syrtis Solutions’ proprietary coverage identification platform, integrates directly with claims processing systems to detect active third-party coverage before payment. This pre-payment verification eliminates redundant spending and demonstrates immediate ROI for both states and MCOs.
The Centers for Medicare & Medicaid Services (CMS) reports that Medicaid’s improper-payment rate reached 5.09 percent in FY 2024, accounting for $31 billion in losses. Nearly 80 percent stemmed from preventable administrative issues rather than fraud or abuse. This represents a massive opportunity for improvement through data-driven solutions like ProTPL.
Real-time COB and TPL technology allow Medicaid plans to move from reactive to proactive management. Instead of chasing dollars after the fact, states can stop the overpayment at the source. For members, that means uninterrupted access to needed services. For taxpayers, it means smarter stewardship of public funds.
Cost Avoidance in Medicaid COB offers a practical way to reduce waste while preserving benefits. As fiscal challenges mount, it’s imperative that states pursue innovation rather than austerity. With the right systems in place, every Medicaid dollar can be accounted for, and every member can receive the coverage they deserve.
Syrtis Solutions’ ProTPL delivers this capability today—enabling Medicaid programs to meet rising demands, comply with integrity standards, and maintain the trust of those they serve. The future of Medicaid depends on efficiency, transparency, and prevention. Real-time COB and TPL innovation make that future possible.
