TPL Advantage®

While regulations support other forms of coverage as primary before Medicaid, there is no single source from which MCOs can easily obtain information on other forms of coverage. Identifying this information can lead to substantial savings for MCOs. Our solution includes dedicated lockbox services offering complete end-to-end processing and accounting and integrates optical character recognition (OCR) to scan and digitize documents received by mail, maintaining a detailed account record.

Data Simplified – Performant Healthcare Solutions^® leverages eligibility information from multiple third party liability (TPL) sources to create a repository of other coverage information. The MCO’s enrollment roster is compared against our robust data warehouse to identify any payers that should be primary to Medicaid. Depending on the MCO’s needs, Performant utilizes the newly discovered coverage information to perform cost avoidance, post-payment recoveries, or both.

Savings Maximized – Performant’s extensive knowledge regarding specialized recoveries and deep relationships with commercial payers result in substantially higher post-payment recoveries than other Medicaid TPL vendors—all supported by transparent reporting to the plan. The flexibility of our platform enables us to design a TPL program specifically for each MCO’s needs, while our extensive resources and dedicated account management ensure expedited and accurate program implementation. Performant’s identification, cost avoidance, billing, and reclamation solutions ensure payment appropriateness and recover payments made by the plan when Medicaid should have been the payer of last resort.

The Problem

• An estimated 13.4% (4.6 million) of Medicaid enrollees have access to other sources of health insurance
• No single database exists for MCOs to identify other coverage information
• Unidentified primary coverage results in improper payments and higher costs for MCOs

The Solution

• Leverage Performant’s extensive coverage database and proprietary algorithms to identify other coverage information
• Deploy Performant’s highly trained team of outreach professionals to work directly with each payer
• Capitalize on established technology and staff expertise to accelerate cost avoidance and/or post-payment recovery efforts