Third-party liability, also referred to as TPL, is the legal obligation of third parties to pay part or all of the costs for medical assistance under a Medicaid state plan. Simply put, if a beneficiary has other forms of health insurance, those primary payers are...
Over the last 56 years, Medicaid has helped deliver health services to the most vulnerable populations in the United States. As member enrollment surges, Medicaid TPL and fiscal accountability have been problematic. To resolve these challenges, numerous legislative efforts have taken place to curb fraud,...
The vast majority of Medicaid improper payments occur because of antiquated data systems that result in eligibility errors. As the Medicaid program has grown, finding primary commercial coverage, also referred to as Third Party Liability (TPL), has become increasingly more complicated and challenging. By law,...
Dependence on the Medicaid program has increased exponentially over time. Presently, it is the single largest insurer in the United States, and in FY 2019, it accounted for over half of all federal monies allocated to states. Regrettably, as the program has grown, waste has...
Medicaid currently fails at providing a system that efficiently and accurately saves and utilizes member data. As Medicaid is a joint state and federally run program, there are many issues with coordinating data platforms. Different states have their own unique data processing and storing, and...
Medicaid has become an integral safety net program that offers 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 insurance...
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...