In the previous post, I discussed how ProTPL uses Rx claims to "trigger" cost avoidance, not only for pharmacy claims, but for medical claims as well. In the case study that started in 2012, we see how this is put

When ProTPL discovers other health insurance, you can reverse the latest claim and ensure that future claims, whether pharmacy or medical, aren’t paid in error. Discovering other health insurance fast, triggered by Pharmacy claims, allows you to intercept the medical

Members of the House Energy and Commerce Committee and Senate Finance Committee sent out a letter to associations serving Medicaid health plans in pursuit of suggestions on best practices connected to cost controls, the use of data and quality of care. The

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

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

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

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

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

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

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