Integrating Third Party Liability (TPL) Across Medicaid Operations and Enterprise Systems in Massachusetts

Abstract

This poster highlights the results of a UMass Medical School partnership with MassHealth, the Massachusetts Medicaid program, to integrate third party liability (TPL) activities across all aspects of the Medicaid program. By embedding TPL at all stages of Medicaid operations and interfacing with all Medicaid systems, the partners optimized identification of and access to TPL sources for all Medicaid members. The TPL activities include eligibility coordination, coverage coordination, payment coordination and recovery coordination. The partnership has achieved over $40 million in cost avoidance through the identification of missed Medicare benefits, over $64 million in cost avoidance over enhanced coordination of benefits and more than $28 million in recoveries in Medicare premium overpayments. Client/Partner: Executive Office of Health and Human Services Presented at the Medicaid Enterprise Systems Conference 2017.