About 13% of Medicaid recipients have unreported primary coverage.
On average less than 17% of the dollars billed to primary insurers are paid back to plans that paid claims in error.
56% of all improper payments in the Medicaid program due to eligibility errors.
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!
To reign in prescription drug costs and increase Medicaid program transparency, New York’s Governor, Kathy Hochul, and the New York Medicaid Redesign Team announced earlier this year that the state would carve-out the prescription drug benefit from the Medicaid program. After being delayed for two......
30 March, 2023
In March 2020, under former Governor Andrew Cuomo’s administration, the New York Medicaid Redesign Team recommended that the state carve-out pharmacy benefits from the Medicaid program due to concerns regarding pharmacy spend and provider transparency. The reform essentially transitions prescription drug reimbursement from a managed care model to......
28 February, 2023
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......
07 February, 2023
