Third Party Liability

The core of third-party liability is ensuring that Medicaid is the payer of last resort. By pursuing payment from other entities for services to Medicaid recipients, states can recover significant costs and save millions.

We employ recognized third-party liability experts with strong academic credentials, legal backgrounds, and professional experience in state and federal government agencies. Our multidisciplinary consultants, with their financial, legal, and clinical knowledge, address these challenges:

  • Identifying individuals eligible for Medicaid who are qualified for, or are already enrolled in other health insurance coverage, performing further investigation, as necessary, to validate data matches, and ensure all other available third-party resources meet their legal obligation to pay claims before the Medicaid program pays for care and services.
  • Lightening a state's financial burden by targeting high-cost, medically complex Medicaid members and connecting them with comprehensive commercial health insurance benefits — ensuring that other insurers cover their legal liability while sharing the costs of care for this population.
  • Recovering Medicaid dollars from liable parties for injuries due to accidents and trauma, and also works with courts and other agencies to identify and recover state funds from probated estates, lifetime liens, special needs trusts, and annuities.
  • Working with state Medicaid agencies to help low-income residents purchase employer-sponsored health insurance, saving millions of dollars each year.
  • Managing business services and operations on behalf of health and human services agencies, including medical billing, accounts receivable management, payment rate setting, cost reporting, and administrative claiming.

Our Results

  • Avoided more than $500 million in costs for the Commonwealth of Massachusetts since the inception of our Enhanced Coordination of Benefits Program.
  • Generated more than $1 billion in annual revenue for the Commonwealth of Massachusetts through our Public Provider Reimbursement services.