Medicaid Cost Containment Solutions

Guiding your route to the cost containment summit 

It’s difficult to scale the cost containment summit. An integrated third party liability (TPL) strategy eases the climb by ensuring that Medicaid is the payer of last resort.

Commonwealth Medicine experts develop strategies to embed and streamline TPL across Medicaid organizations including:

  • Front-end eligibility reviews
  • Service delivery
  • Claims processing and coordination
  • Back-end recovery
  • Program integrity

TPL identifies other insurance and resources that are responsible for reimbursing Medicaid expenses, making it possible to use dollars recovered and saved to develop, deliver and sustain a broader range of member services and programs.

Since 2013, our TPL strategies have helped the Massachusetts Medicaid program, MassHealth, achieve more than $500 million in cost avoidance and generate more than $1 billion in annual revenue.

TPL Integration Opportunities

  • Eligibility Coordination – We ensure current and potential access to TPL coverage is identified and secured through data matching, analysis, outreach, and purchasing.
  • Coverage coordination – Our team verfies that TPL resources provide all appropriate coverage and benefits.
  • Payment coordination – We make sure Medicaid is paying at its lowest liability after all TPL resources have been exhausted.
  • Recovery coordination – Our team ensures that Medicaid payments are recovered from TPL resources if costs cannot be avoided up-front.

Check out our presentations and panels at MESC 2019:

Tuesday 8/20, 2:15 p.m., Room W180

“Subrogation Rhapsody:  How to harmonize your subrogation efforts for maximum results.”

Jenifer Hartman, deputy director for Benefit Coordination, will moderate a panel:

  • Matt Smith, Vice President, Subrogation Operations, HMS
  • David Smith, Manager, Third Party Liability and Recoveries, State of Colorado
  • John Cofield, Manager, Subrogation Recoveries, State of Florida

Tuesday 8/20, 5:15 p.m., Room W180

“Medicare Buy-In Initiatives and Systems in Various States”

Jenifer Hartman, deputy director for Benefit Coordination

Wednesday 8/21, 1:45 p.m., Room W180

“A Proactive Approach to TPL: Strategies to Identify and Convert Potential Access to Other Insurance to Active TPL Coverage for Medicaid Members”

  • David Greco, MassHealth, Massachusetts Executive Office of Health and Human Services
  • Jen Hartman, Commonwealth Medicine
  • Jeannette Lynch, Commonwealth Medicine

Tuesday 8/20, 6:15 – 8 p.m., Exhibit Hall

Poster presentation: “A Proactive Approach to TPL:  How Massachusetts Integrates Third Party Liability (TPL) with Medicaid Operations and Enterprise Systems to Maximize Benefits and Savings”

Jen Hartman, deputy director for Benefit Coordination