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.

eprescribing (6)

 

 

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!

  • CMS_BannerImage
    Medicaid’s Wasteful Spending – The Numbers

    The CMS has witnessed a dramatic surge in improper Medicaid payments and says the Affordable Care Act could be the cause. The Medicaid improper payment rate has jumped from 5.8% or $14.4 billion in fiscal 2013 to 9.78% or $29.12 billion in fiscal 2015, according......

  • US_House_Committee
    Medicaid Improper Payment Rate Continues to Grow

    Last month Congress held a hearing concerning the escalating number of improper payments in Medicare and Medicaid. The House oversight panel reviewed concerns regarding escalating improper payment rates discovered by federal oversight groups which include the Government Accountability Office (GAO) and the Health and Human Services......

  • syrtis-34
    How Rx Claims Trigger OHI Discovery & Cost Avoidance

    When ProTPL discovers other health insurance, you can reverse the latest claim and ensure that future claims, whether pharmacy or medical, aren’t paid in error. Discovering other health insurance fast, triggered by Pharmacy claims, allows you to intercept the medical claims, such as office or......