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...
Over the last fifty years, Medicaid has helped deliver health services to the most vulnerable populations in the United States. As member enrollment surges, Medicaid TPL and fiscal responsibility have been problematic. To address these challenges, numerous legislative efforts have occurred to curb fraud, waste,...
The majority of Medicaid improper payments occur because of antiquated data systems that result in eligibility errors. As the Medicaid program has grown, determining primary commercial coverage, also referred to as Third Party Liability (TPL), has become significantly more complicated and challenging. By law, Medicaid...
Dependence on the Medicaid program has increased exponentially over time. Currently, it is the single largest insurer in the United States, and in 2019, it accounted for more than half of all federal funds distributed to states. Regrettably, as the safety net program has grown,...
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...
The federal government doled out almost $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 various requirements for the Medicaid program, which the federal...