DAILY ANALYSIS SERVICE FOR FINDING MEDICAID OHI
Rather than recovering less that 10 cents for every dollar spent on third party liability efforts, we’d rather avoid future managed Medicaid claims by auditing member eligibility everyday using their Medicaid pharmacy claims.
SERVICE BENEFITS INCLUDE:
- Prepayment identification of Medicaid users with Other Health Insurance (OHI)
- Captures savings for both pharmacy and medical OHI segments
- Four times the coverage segments identified versus traditional COB
- Free evaluation of OHI within Medicaid pharmacy claims and “No Risk” business model
CostAvoidTPL Data Flow
What will we need for a free CostAvoidTPL evaluation?
- Enrollment Data Test: Health Plan provides a sample of recent Rx claims for review, and RxEOB will return a FREE assessment of opportunity (with a custom savings estimate).
- Implementation: Data formats and file exchange processes will be established — and implementation can occur in as little as 60-90 days
- Cost Avoidance: The day after the program is activated, the Health Plan will begin cost avoiding prescription drug claims.
- Results: Guarantee ROI is usually achieved within 60 days of program running daily Medicaid pharmacy claim audits.