Benefit Identification

As Medicaid costs continue to rise, it is becoming increasingly important for states to contain costs and resources, while ensuring individuals receive all the benefits to which they are entitled. One way to do this is through effective benefit identification activities — finding other payers, in addition to Medicaid, that are responsible for benefits.

Our financing experts bring policy, operational, and benefit coordination expertise to employ sophisticated data-matching tools and proprietary algorithms — identifying identify additional benefits for Medicaid recipients and sources of revenue through cost avoidance, savings, and recoveries. In one initiative, we helped three states save and recover more than $99 million in improper Medicare premiums since 2008.

We have developed a number of services to identify additional benefits that Medicaid members may be eligible for, while also saving Medicaid millions of dollars by ensuring it is the payer of last resort.

  • Enhanced Coordination of Benefits investigates the availability of commercial insurance plans and coordinates payment for Medicaid populations with complex, high-cost conditions.
  • Premium Assistance purchases private group health insurance on behalf of qualified Medicaid members.
  • Medicare and Disability Entitlement Correction identifies Medicaid recipients with disabilities who have been missed or mistakenly denied for Social Security and/or Medicare benefits –including dual eligibles – and helps with corrections.
  • Medicare Outreach and Enrollment identifies Medicaid members over the age of 65 who qualify for but do not receive Medicare – and enrolls them.
  • Medicare Data Assurance Review integrates state and federal data and identifies Medicare information for Medicaid members that was not found previously by the state.
  • Medicare Premium Payment Review first identifies and then works to correct and recover erroneous state Medicare premium payments.