OIG collaborates with MCOs to improve efficiency
OIG Third Party Recoveries (TPR) kicked off a project with the Texas Medicaid and Healthcare Partnership Third Party Liability (TPL) area to improve processes and increase training opportunities. The project focuses on activities related to Other Health Insurance (OHI) identification and training that assists MCOs with coordination of benefits to ensure Medicaid is the payer of last resort.
Adopted initiatives include moving to a new medical data matching system to increase cost avoidance potential; analyzing Pharmacy Benefit Managers OHI records to eliminate duplicate records; and beginning a supplemental quality review of daily Pharmacy OHI and strengthen communication between TPR and TPL.
Under TPR’s direction, TPL has arranged additional trainings to assist the MCOs with a better understanding of how to read and use other insurance files for their TPL activities. TPL’s purpose is to reduce Medicaid expenditures by shifting claims expenses to third-party payers. TPL ensures Medicaid is the payer of last resort through cost avoidance and recovery efforts.
These enhancements are intended to increase efficiencies during the MCOs report submission process and during TPRs monitoring and data reporting processes.