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.

 

 

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!

  • COB MEDICAID TPL OHI SYRTIS SOLUTIONS
    IDENTIFYING TPL IN THE MEDICAID PROGRAM

    The vast majority of Medicaid improper payments occur due to antiquated data systems that result in eligibility errors. As the program has grown, identifying primary commercial coverage, also known as Third Party Liability (TPL), has become increasingly more complex and challenging. By law, Medicaid plans......

  • MEDICAID NEWS SEPTEMBER 2021 SYRTIS SOLUTIONS
    MEDICAID NEWS RECAP – SEPTEMBER 2021

    Syrtis Solutions distributes a monthly Medicaid news summary to help you stay up-to-date. The monthly roundup focuses on developments, research, and legislation that relates to Medicaid program integrity, cost avoidance, coordination of benefits, improper payments, fraud, waste, and abuse. Below is a summary of last......

  • PROTPL CAN SAVE MEDICAID BILLIONS IN IMPROPER CLAIMS PAYMENTS SYRTIS SOLUTIONS
    MEDICAID TPL SOLUTION PRESENTS SIGNIFICANT SAVINGS OPPORTUNITY

    Dependence on the Medicaid program has increased exponentially over time. Currently, it is the single largest insurer in the United States, and in FY 2019, it accounted for more than half of all federal funds distributed to states. Unfortunately, as the safety net program has......