Third-party liability, also known as TPL, is the legal obligation of third parties to pay part or all of the expenditures for medical assistance under a Medicaid state plan. In other words, if a beneficiary has other forms of health insurance, those primary payers are...
Medicaid currently fails at providing a system that efficiently and accurately stores and utilizes member data. As Medicaid is a joint state and federally run program, there are many problems with coordinating data platforms. Different states have their own unique data processing and storing, and...
Medicaid has evolved to become an integral safety net program that provides access to health care for millions of Americans. Payment for this health care is either delegated to Medicaid or other third party insurance coverage. In 2012, 7.6 million people on Medicaid had other...
The federal government doled out close to $100 billion in "improper" Medicaid payments in 2021-- accounting for about one-fifth of all Medicaid payments, according to estimates. The figure represents Washington's current accounting of payments that didn't meet the numerous criteria for the Medicaid program, which the...
The Social Security Act, signed into law by President Franklin Roosevelt in 1934, specifies in statute § 1902( a)( 25) of the law "...
The vast majority of Medicaid improper payments occur due to antiquated data systems that result in eligibility errors. As the program has grown, identifying primary commercial coverage, also known as Third Party Liability (TPL), has become increasingly more complex and challenging. By law, Medicaid plans...
Dependence on the Medicaid program has increased exponentially over time. Currently, it is the single largest insurer in the United States, and in FY 2019, it accounted for more than half of all federal funds distributed to states. Unfortunately, as the safety net program has...
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,...
Since Medicaid’s inception in 1965, the program has expanded to become the largest provider of healthcare coverage in the country. As the member population size has grown, Medicaid third party liability (TPL) efforts and fiscal responsibility have been reoccurring issues. To protect Medicaid’s solvency, there...
Identifying third party liability continues to be a challenge under the coordination of benefits for Medicaid plans. By law, plans are payers of last resort so whenever beneficiaries have other active coverage (OHI), those third parties should pay first. Currently, Medicaid plans are required to...