Third Party Recovery efforts work to preserve Medicare funds

OIG Third Party Recoveries (TPR) collaborated with HHS and Texas Medicaid’s claims administrator on implementation of the following initiatives to help improve MCOs’ performance of Third-Party Liability activities. Third-party recovery involves any individual, entity or program, including health insurance, that may be legally liable to pay all or part of a client’s medical costs before Medicaid dollars are spent. These enhancements, along with updates to MCO contract requirements, assist MCOs in maximizing cost avoidance and cost recovery efforts:

• An improved data match process was implemented in October 2020 to increase identification of other insurance and provide more accurate and timelier other-insurance data. The new data match process increased cost avoidance by 32 percent, to $25,196,255, for FY 21.
• A clean-up project of pharmacy records was implemented in December 2020. The ongoing project identifies other-insurance policy information and voids duplicate and invalid records, resulting in improvements to the quality of data in the pharmacy system.