Cost avoidance gives Medicaid health plans an opportunity to reduce unnecessary claims expenditures by establishing insurance responsibility before payment occurs. Rising healthcare costs and increasing demands on state Medicaid budgets have made this capability especially important. Recent actions involving Michigan's coverage reporting process, federal insurance...
Third-party liability, also known as TPL, is the legal requirement of third parties to pay part or all of the costs 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 saves and utilizes member data. As Medicaid is a joint state and federally managed program, there are many issues with coordinating data platforms. Different states have their own unique data processing and storing, and...
Medicaid has become an essential safety net program that delivers 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 private health...