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!

  • Virginia Medicaid Expansion Syrtis Solutions
    Virginia Medicaid Expansion “Probable”

    It has been six weeks since Virginia’s General Assembly met for a special session to produce the state’s budget for FY 2019 and decide the fate of Medicaid expansion. On Tuesday, the Finance Committee met but Virginia Senate Republicans delayed a decision on a proposed......

  • medicaid 1115 waivers
    States look to use medicaid 1115 waivers to drop key provisions of the program

    The repeal of the Affordable Care Act with its current provisions for Medicaid did not materialize at the federal level last year; however, states are exploring reform individually by way of Medicaid 1115 waivers. These waivers focus on priorities within the states and permit local governments......

  • medicaid expansion
    Medicaid Expansion Round-Up

    During the 2016 Presidential campaign and shortly after assuming office, President Trump was adamant about repealing the ACA’s provisions for Medicaid expansion. In fact, President Trump and the administrator of The Centers for Medicare and Medicaid Services (CMS), Seema Verma, are now considering waivers to......