The solution needed to replace “Pay & Chase” with prospective “Cost Avoidance”.
Real-time cost avoidance technology for Medicaid and Medicare.
Discover how real-time cost avoidance can protect your Medicaid plan’s bottom line. Request a free demo and see why leading MCOs trust Syrtis Solutions.
Unreported coverage and inefficient recovery methods are draining Medicaid budgets — and most plans don’t even realize the true impact until it’s too late.
Our real-time cost avoidance platform connects your claims process with the industry’s largest commercial coverage database — helping you prevent unnecessary payments before they happen.
The industry needed a solution for the challenges of data quality and timeliness.
The solution needed to provide Active coverage on Utilizing members (Not old – stale data).
The Medicaid market needed a technology based solution that fits in with any TPL program.
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.
Discover how Syrtis Solutions can help your plan prevent improper payments, boost financial performance, and stay ahead of compliance requirements.
Everything you need to know about how Syrtis Solutions protects your Medicaid plan and simplifies cost avoidance.
Syrtis consultants are readily available to conduct a claims analysis and provide quantitative reports that outline savings potential.
To learn more, or to schedule a free claims analysis, contact Stephen Konsin at NKonsin@SyrtisSolutions.com or 866-960-9358.
Program implementation can occur as quickly as 60 days and requires very little technical resources from our customer. Essentially just creating a new file output and secure file transfer process.
The implementation timeline is dependent only on the length of time needed to reach an agreement and set up the files transfer processes. ProTPL uses standard NCPDP Pharmacy and ANSI 12 eligability datasets.
ProTPL is seamlessly integrated into NCPDP Pharmacy and ANSI 12 eligibility standards to avoid disruption at the point of sale for both the pharmacy and the patient.
After the initial claim is filled, all future claims are cost avoided automatically as the pharmacist has updated the system to prospectively channel the claim to the other health plan.
ProTPL is designed to help governmental agencies, MMIS providers, pharmacy benefit managers (PBM) and payer of last resort health plans reduce manual pay and chase processes that retrospectively identify and track down primary payers for reimbursement.
In addition to a transparent provider model, the program is available as a private-label solution.
Test data demonstrates that between 6% – 13% of all claims submitted under payer of last resort health plans, excluding Part D, are found to have other pharmacy coverage. Through a prospective cost avoidance solution, claims with other coverage are identified in real-time at the pharmacy point of sale.
In addition to cost avoidance, this information is used to retrospectively recover pharmacy claims previously approved, as well as to identify additional medical dollars that can be recovered both retrospectively and prospectively. The program complies with all federal TPL requirements and reduces inefficient pay and chase methodologies.
All private or public healthcare plans, unless specifically excluded by Federal statute, must meet third party liability (TPL) legal obligations to pay claims before Medicaid, or other federally-sponsored healthcare programs.
ProTPL, a service of Syrtis Solutions, enforces TPL obligations to effectively cost avoid pharmacy claims in real-time when other coverage outside of Medicaid exists. In addition to cost-avoiding pharmacy claims, the program helps to identify, recover and cost-avoid medical claims.
1601 Rio Grande, Suite 330, Austin, TX 78701
Phone: 866-960-9358
Email: info@syrtissolutions.com