Third parties are organizations or people who are legally liable for paying the healthcare claims of Medicaid beneficiaries. Federal legislation and policies mandate states to guarantee that Medicaid is to be the payer of last resort. Medicaid beneficiaries are consequently obligated to utilize all other...
With the increased awareness that government officials have paid to the need for accurate Medicaid claims information within federal government healthcare systems, one may have expected that now, nearly two years since an inspector general testified that much of the data used to identify improper...
The intent of the Effective Practices Guide, presented by CMS in collaboration with various state COB/Third Party Liability units is to provide state Medicaid agencies with information on practices that could assist states in improving their identification and successful pursuit of legally liable third party...
It’s not easy to discover primary commercial coverage on your plan’s members at the point of sale—costing you time and money chasing reimbursements for claims that others should have paid. And so far with little luck: on average less than 17% of the money billed...
In a one year case study with a Medicaid plan, we found that, on average, 1.3% of utilizing members where identified as having other insurance. In other words, Syrtis processed nearly 3 million pharmacy claims and returned approximately 38,000 members identified with other primary insurance....
Syrtis Solutions developed ProTPL, a real-time point of sale cost avoidance service for the payer of last resort market. ProTPL offers the most active and current primary pharmacy coverage information from any vendor in the market. Up to 4 times more coverage information! ..and in real-time, at...
The watchdog for the U.S. Congress, the Government Accountability Office (GAO), designates Medicare and Medicaid as a high-risk plans, because it’s a complicated program, which is in danger from fraudulent activity. Fraud, in this case, involves deception resulting in a profitable gain at the expense...
The Government Accountability Office (GAO), the watchdog for the U.S. Congress, determined that Medicaid and Medicare as programs with potential for a high risk of abuse, waste and fraud. In the case of Medicaid, the GAO says inadequate fiscal oversight might result in improper expenditures....
Syrtis Solutions is pleased to be an exhibitor and presenter at the 2013 Anti-Fraud Exposition coordinated by the National Health Care Anti-Fraud Association. Established in 1985 by multiple private health insurers and federal and state government executives, the National Health Care Anti-Fraud Association is definitely...
A September 2001 report entitled “Medicaid Recovery of Pharmacy Payments by Liable Third Parties” by the U.S. Department of Health and Human Services’ (HHS) Office of Inspector General (OIG), who is charged with protecting healthcare cost containment and the integrity of HHS programs, found that...
