Medicaid

MEDICAID TPL AND IMPROPER PAYMENTS LEGISLATION SYRTIS SOLUTIONS

30 Aug MEDICAID TPL AND IMPROPER PAYMENTS LEGISLATION

Over the last 56 years, Medicaid has helped provide health services to the most vulnerable populations in the United States. As member enrollment surges, Medicaid TPL and fiscal responsibility have been problematic. To resolve these issues, several legislative efforts have occurred to curb fraud, waste,...

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MEDICAID PHARMACY CARVE-OUT SYRTIS SOLUTIONS PROTPL

29 Jul MEDICAID PHARMACY CARVE-OUTS

    Wisconsin Pharmacy Carve-Out Last year, the Wisconsin Department of Health Services carved out prescription drugs from the Family Care Partnership Program and transitioned to a Fee-for-Service (FFS) delivery model. The carve-out ensured compliance with the 2020 Medicaid and CHIP Managed Care Final Rule and eliminated the...

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30 Jun MEDICAID CAN SAVE MILLIONS WITH E-PRESCRIBING

Medicaid payers of last resort face the challenging task of recovering claims payments made in error when program beneficiaries fail to report primary coverage information at the time services are provided. Plan members do not share other coverage information for a multitude of reasons, but...

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Cost Avoidance Coverage Eligibility Enrollment Medicaid 2021 Medicaid Financing ProTPL Section 1115 Waivers Syrtis Solutions

29 Jan MEDICAID IN 2021

The Coronavirus pandemic and the consequential economic recession accentuated the importance of the Medicaid program last year. By February, the Medicaid enrollment rate increased to 7.4 percent, and 76.5 million people were enrolled in the jointly funded program. In 2021, the new administration, economy, and...

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MEDICAID IMPROPER PAYMENTS SYRTIS SOLUTIONS CMS FY 2020

18 Dec $86.49 BILLION IN MEDICAID IMPROPER PAYMENTS

Medicaid is the single largest payer of health care in the United States. As the program has grown in size and scope, it has struggled with fraud, waste, abuse, and improper payments. Over the years, there have been a number of federal initiatives to rein...

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2020 Medicaid Managed Care Final Rule CMS2408F Syrtis Solutions

01 Dec Medicaid Managed Care Final Rule – CMS-2408-F

The Medicaid Managed Care Final Rule, CMS-2408-F, was finalized this November. The new rule implements proposals from the Notice of Proposed Rule Making from last year. Provisions from the rule will begin taking effect as early as December 14, 2020.   According to Medicaid enrollment data from 2018, 66...

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Medicaid Syrtis Solutions Medicaid Enrollment CARES Act Healthcare Coronavirus Recession

30 Oct MEDICAID ENROLLMENT SPIKED 5.7%

Data from the federal government indicates that more than 4 million people enrolled in the Medicaid program this spring due to the pandemic driven economic downturn. The 5.7% spike came after the surge in unemployment and the loss of corresponding employer-sponsored healthcare coverage. In response...

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prescription drug costs pharmacy benefits carve out medicaid syrtis solutions

25 Aug PRESCRIPTION DRUG COSTS LEAD TO CARVE-OUT IN OHIO

In addition to the pandemic driven economic downturn and the consequential surge in Medicaid enrollment, rising prescription drug costs in the Medicaid program have caused tremendous fiscal pressure on state budgets over the years. In 2017, pharmaceuticals accounted for 5.1 percent of Medicaid benefit spending, and this expense...

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