Government expenditures for Medicaid managed care embodied more than one-third of the total government Medicaid spending in 2014, according to a government report (GAO-16-77) released Jan. 19 that highlights exactly how states are increasingly relying on managed care as they expand Medicaid coverage within the...
In September, The Globe Gazette reported that Iowa representatives have turned in waiver requests with the federal government as a part of Gov. Terry Branstad's strategy to switch Medicaid to a privately run managed care system effective Jan. 1 - a shift they anticipate will deliver...
Why GAO Did This Study During fiscal year 2013, Medicaid - collectively funded by states and the federal government - delivered health care insurance coverage to over 70 million people at an overall cost of about $460 billion. Our lawmakers generally established Medicaid as the health...
Recently, I got into a discussion with a state Medicaid TPL director about RFPs for third party liability cost avoidance work. I feel that our cost avoidance solution would greatly benefit state-run plans, but RFPs are nearly always written for a single vendor to handle an assortment of...
E-Perscribing: What it is, how it works, and how it can help Medicaid save millions of dollars Payer of last resort providers face the difficult task of recovering payments when the recipient does not present primary coverage information at the time services are rendered. For a...
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 leaders want to gain a...
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...
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...
