THE CHALLENGES OF EVERY TPL PROGRAM

13%

Unreported Coverage

About 13% of Medicaid recipients have unreported primary coverage.

17%

Dollars Recovered

On average less than 17% of the dollars billed to primary insurers are paid back to plans that paid claims in error.

56%

Wasteful Spending

56% of all improper payments in the Medicaid program due to eligibility errors.

WHAT SYRTIS SOLUTIONS RECOGNIZED

The industry needed a solution for the challenges of data quality and timeliness.

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”.

 

 

BIGGER DATA, SMARTER DELIVERY

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 BLOG

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!

  • Medicaid Pay And Chase
    Tackle Medicaid’s Improper Claims Payments With Data, Not ‘Pay and Chase’

    The federal government must quickly move away from the “Pay and Chase” model where Medicaid routinely makes improper claims payments (those that were the liability of primary insurance plans), then retrospectively identifies the claims with third party liability. To make this change, the government must......

  • Kaiser Family Foundation
    The Consequences of Repealing the ACA Medicaid Expansion

    While the Senate considers the Obamacare Repeal Reconciliation Act of 2017, the Kaiser Family Foundation recently reported on the main provisions that would effect Medicaid; they are, the removal of statutory authority to cover childless adults up to 138% FPL ($16,643 for an individual in......

  • Medicaid Survey
    Medicaid Enrollees Generally Happy With Program

    Enrollment surveys have shown that healthcare options under Medicaid programs are acceptable to enrollees. Enrollees have reported in a nationwide survey that the healthcare they receive under Medicaid is more than adequate. Researchers at Harvard T.H. Chan School of Public Health discovered that in general,......