Blog

17 Mar The Increasing Cost of Improper Payments Made by Mediciad

Federal agencies issued an assessed $136.7 billion in incorrect payments during fiscal year 2015, the greatest yearly tally since 2004 when agencies first began reporting data on the subject. As in past years, the Medicare and Medicaid programs accounted for the majority of the overall total...

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25 Jan Trends is Medicaid Managed Care Spending

Government expenditures for Medicaid managed care embodied more than one-third of the total government Medicaid spending in 2014, according to a government report (GAO-16-77) released Jan. 19 that highlights exactly how states are increasingly relying on managed care as they expand Medicaid coverage within the...

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07 Oct Iowa Moving to Total Medicaid Managed Care

In September, The Globe Gazette reported that Iowa representatives have turned in waiver requests with the federal government as a part of Gov. Terry Branstad's strategy to switch Medicaid to a privately run managed care system effective Jan. 1 - a shift they anticipate will deliver...

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19 Aug Identifying Third Party Liability on Your Medicaid Members

There are many ways during Medicaid enrollment and claims processing to identify if a member has primary coverage. The discovery of other health information occurs in three points; during the application process, prospectively when claims are processed, and post-payment (Pay & Chase). By simply deploying...

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10 Oct How Rx Claims Trigger 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...

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