Unreported Coverage

About 13% of Medicaid recipients have unreported primary coverage.


Dollars Recovered

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


Wasteful Spending

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


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”.




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!

  • Medicaid Expansion
    Majority of Utah Residents Support the Expansion of Medicaid Under ACA

    Just under 60% of Utah residents support the expansion of Medicaid under the ACA in order to cover a greater number of low-income adults, according to a recent poll. A strong majority of Utahns back a full Medicaid expansion, according to the poll conducted by Dan Jones and......

  • GAO Medicaid Fraud
    GAO Reports $95 Billion Wasted in Fiscal 2016

    The GAO reported this week that The Centers for Medicare & Medicaid Services must create a much more robust risk-based anti-fraud strategy for the Medicare and Medicaid programs. Improper payments within both programs amounted to about $95 billion in fiscal 2016. The Government Accountability Office,......

  • 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......