About 13% of Medicaid recipients have unreported primary coverage.
On average less than 17% of the dollars billed to primary insurers are paid back to plans that paid claims in error.
56% of all improper payments in the Medicaid program due to eligibility errors.
The Medicaid market needed a technology based solution that fits in with any TPL program.
The solution needed to provide Active coverage on Utilizing members (Not old – stale data).
The solution needed to provide Active coverage in Real-Time.
The solution needed to replace “Pay & Chase” with prospective “Cost Avoidance”.
Claims are checked against an e-prescribing master patient index of over 280 million commercially covered lives. This is the largest and most complete database of active healthcare coverage in the nation. This means your Medicaid plan will obtain the best and latest eligibility responses when you need them – saving you the cost of recovery.
Syrtis Solutions stays on the cutting edge of technology, trends and new legislation regarding healthcare cost containment. Keep up to date by visiting our blog!
As of March 18th, Medicaid Managed Care Organizations are confronting significant challenges due to proposed federal budget cuts totaling $880 billion over the next decade. These reductions threaten to reshape Medicaid funding, potentially leading to coverage losses and stricter eligibility requirements. Consequently, MCOs may experience......
21 March, 2025
As previously discussed, potential federal budget cuts pose significant threats to Medicaid, impacting millions who rely on this essential program. Recent developments across various states highlight the urgency for proactive measures to mitigate these challenges. California’s Financial Measures California has borrowed $3.4 billion from......
14 March, 2025
Syrtis Solutions distributes a monthly Medicaid news summary to help you stay up-to-date. The monthly roundup focuses on developments, research, and legislation that relates to Medicaid program integrity, cost avoidance, coordination of benefits, improper payments, fraud, waste, and abuse. Below is a summary of last......
06 March, 2025
