ACAP RECOGNIZES SYRTIS SOLUTIONS AS A PREFERRED VENDOR

Syrtis Solutions, a leading provider of real-time Other Health Insurance (OHI) coverage information for payers of last resort, just recently accomplished a significant milestone by being identified as a preferred vendor for the Association for Community Affiliated Plans (ACAP). This designation is a reflection of Syrtis Solutions' commitment to decreasing costs and improving operational efficiency for government-funded health plans.

The Significance of Cost Avoidance in Medicaid

The Medicaid landscape is complex and continually evolving, with state and federal guidelines mandating strict cost-control measures to protect the program's sustainability. One of the fundamental methods for managing costs in Medicaid programs is avoiding improper claims payments, which involves identifying third-party liability (TPL) and ensuring that Medicaid is the payer of last resort.

Without effective cost avoidance tools, Medicaid programs can suffer from unnecessary expenditures, driving up costs and redirecting resources away from other vital healthcare needs. This is where Syrtis Solutions has been making a significant impact.

Syrtis Solutions: Pioneers in Real-Time Cost Avoidance

Founded in 2008, Syrtis Solutions has been at the forefront of developing innovative solutions to deal with the challenges of OHI identification and cost avoidance. Their flagship product, ProTPL, is a real-time pharmacy cost avoidance solution that provides Medicaid and other government-funded health plans with immediate access to actionable data. By quickly identifying whether a member has other insurance coverage, ProTPL helps plans avoid paying for claims that should be covered by a liable third-party payer. This not only helps Medicaid plans comply with federal regulations but also significantly reduces the time and effort required to manually identify third-party insurers and recover costs retroactively.

What It Means To Be An ACAP Preferred Vendor

ACAP is a national trade association that represents 78 nonprofit Safety Net Health Plans, covering more than 25 million individuals through Medicaid, Medicare, and other public health programs. ACAP's Preferred Vendor program is designed to spotlight companies that offer valuable services to member health plans and have a proven track record of improving the quality and efficiency of care.

By becoming an ACAP Preferred Vendor, Syrtis Solutions has joined an elite group of companies that have exhibited a strong commitment to serving community health plans. This designation demonstrates Syrtis Solutions' expertise and reliability in the Medicaid space, as well as its dedication to helping ACAP member plans improve cost-avoidance efforts.

Looking Ahead

As healthcare costs continue to increase and Medicaid plans face increasing pressure to control expenditures, the role of payment integrity will only grow in importance. With its newly cemented status as an ACAP Preferred Vendor, Syrtis Solutions is well-positioned to help all payers of last resort maneuver these challenges, making certain that limited healthcare dollars are used efficiently and effectively.

Syrtis Solutions' innovative real-time cost avoidance technology, combined with its proven expertise, offers an essential resource for Medicaid plans seeking to enhance their operational efficiency and reduce unnecessary spending. This partnership marks a significant step forward in improving Medicaid cost management and patient care across the country.

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THE ASSOCIATION FOR COMMUNITY AFFILIATED PLANS PUSHES BACK ON PROPOSED MEDICAID CUTS

by Howard Green

The Association for Community Affiliated Plans (ACAP) has launched a massive advertising campaign imploring Republican senators from Medicaid expansion states to oppose any Medicaid cuts.

The message from ACAP: Medicaid is economically critical because it supports workers.

“Medicaid cuts will put millions of jobs at risk,” the advertisement says.

The television ads will be on the air in Colorado, Arizona, West Virginia, Ohio and Nevada — Republican swing states that expanded Medicaid. These states have at least one moderate Republican senator who has conveyed trepidations over changes to Medicaid.

The Association for Community Affiliated Plans represents Medicaid plans that administer the program for more than 20 million enrollees in 29 states.

“We are reminding Senators that protecting Medicaid protects workers and small businesses in their states — half of working people who rely on Medicaid for coverage work for small businesses,” said Margaret A. Murray (ACAP CEO) in a recent press release.

ACAP does not support the current bill from the Senate, called the Better Care Reconciliation Act (BCRA), stating in a letter that “because the BCRA makes massive cuts to federal Medicaid funding and does not protect plans from unsound rates, ACAP has no choice but to oppose this legislation.”

Medicaid has surfaced as one of the most challenging concerns of repealing and replacing the Affordable Care Act. Senators from expansion states do not want to responsible for their constituents losing coverage, while the other Senators don’t want to be rebuked for holding fast to conservative principles.

In a report, the Congressional Budget Office (CBO) projected the BCRA would lead to a reduction of 15 million Americans on Medicaid by 2026. The bill includes a $772 billion reduction in Medicaid funding for the poor and disabled.

The Better Care Reconciliation Act phases out the ACA’s Medicaid expansion starting in 2021, and would regress to pre-ACA levels by 2024.

Many moderate Republican senators, such as Rob Portman (Ohio) and Shelley Moore Capito (W.Va.), were promoting a 7-year phase out of additional federal funding for Medicaid expansion. Neither one of them has communicated how they would vote on the bill; however, last Friday, Senator Dean Heller (R-Nev.) said that he was in opposition to the bill in its current incarnation. Last weekend, Senator Ben Sasse from Nebraska said the bill doesn’t really repeal the ACA but is “largely a Medicaid reform package.”

Read more here.