Stop improper payments before they happen instead of trying to recover them later.
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Syrtis Solutions identifies active commercial coverage in real time using coverage data, so Medicaid pays only when it is responsible.
Built for state Medicaid programs and Medicaid health plans
Complete the form to receive an estimate of potential annual cost avoidance for your Medicaid program.
No commitment. No disruption to current operations.
One of the largest sources of preventable Medicaid spending occurs when active commercial coverage is not known at the time a claim is processed.
Coverage changes happen every day, but updates often do not appear in time through batch feeds or eligibility reviews.
As a result, Medicaid pays as primary when another insurer is responsible.
That means improper payments, avoidable losses, and fewer dollars available for beneficiary care.
Very close to yours, just sharper.
Most Medicaid programs rely on post payment recovery to address improper payments.
By the time other coverage is identified, the claim has already been paid. Recovery rates are low, administrative effort is high, and the dollars are often never fully returned.
Even when funds are recovered later, those payments still count as improper under audit standards.
The issue is not care use. The issue is paying the wrong payer.
This lands harder and avoids overexplaining.
Syrtis helps Medicaid programs identify other active insurance coverage in real time, so claims are routed correctly before payment occurs.
Identify active commercial coverage at the moment claims are processed.
Prevent decisions based on outdated or incomplete coverage information.
Works alongside existing TPL and recovery programs with minimal disruption.
Stop improper payments before they happen instead of trying to recover them later.
By preventing improper payments, Syrtis helps Medicaid programs protect limited resources while reducing recovery workload.
Enter your Medicaid member population and average utilization costs to see an estimated annual savings opportunity from preventing improper payments.
This estimate provides a directional view of potential impact. A claims file evaluation can confirm exact value for your program.
Pharmacy claims are reviewed using real time coverage data.
Syrtis detects when another insurer should pay first.
Medicaid avoids paying as primary when it is not responsible.
Programs see measurable savings without disrupting existing operations.
Everything you need to know about how Syrtis Solutions protects your Medicaid plan and simplifies cost avoidance.
Yes. Syrtis provides a free savings analysis and can validate results through a claims file evaluation.
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.
No. Claims continue to process normally with no added burden on providers or beneficiaries.
State Medicaid agencies, Medicaid managed care organizations, and payer of last resort programs.
The opportunity varies by program. Syrtis helps identify this quickly using real time coverage data.
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.
Improper payments reduce the resources available for beneficiary care.
Get a clear estimate of your potential annual cost avoidance and validate the opportunity with a simple evaluation.
No obligation. No disruption to current operations.
Or call to speak with a Medicaid payment integrity specialist.
