3 Ways to Better Manage Medicaid Claims

An often seen practice for Medicaid beneficiaries is to have one or more additional sources of healthcare coverage or services. These users are known to have Other Health Insurance (OHI) and because U.S. healthcare law indicates all third parties have an obligation to pay part or all of a user’s medical expenditures before Medicaid kicks in, health plan providers have a lot to manage.

Cost avoidance is an important aspect of dealing with Medicaid, as efforts to determine Third Party Liability (TPL) is a costly practice. Providers receive a portion of every dollar spent on TPL efforts, but the act of finding Medicaid OHI can result in small or even negative ROI. As a leading healthcare software provider, RxEOB understands the difficulty associated with Medicaid and TPL and has listed below some top ways to better manage these claims.

• Run pharmacy claims audits: One of the best ways to manage cost avoidance is to audit users’ Medicaid pharmacy claims. By looking at member eligibility on a regular basis, you can better avoid future managed Medicaid claims all together.
• Better manage COB: When a user has health coverage through a third party, coordination of benefits (COB) refers to the activities involved with determining the need for Medicaid coverage. Traditional methods are relatively time consuming, but by running daily automatic audits, you can increase the identified coverage segments by up to four times.
• Look at both pharmacy and medical: There are two types of OHI segments – medical and pharmacy. By looking at each for individuals, you can better capture the savings associated with other providers to increase the cost avoidance of Medicaid.

Utilizing advanced software is now the ideal method of finding Medicaid OHI to heighten TPL efforts. Through technology, you can run daily audits to better manage how you deal with Medicaid. To find out more, contact RxEOB today.