Two information technology companies have teamed up to offer state Medicaid programs a service that could save the states millions, according to company officials.
Affiliated Computer Services, a large IT services and outsourcing company that does substantial Medicaid business, and RxHub, which maintains a master patient index of 200 million patient records that includes insurance coverage for prescriptions, announced the new service this month.
In states that contract for the service, ACS will supply pharmacies with point-of-sale information on prescription coverage for Medicaid patients. According to a 2006 Government Accountability Office report, an average of 13 percent of Medicaid patients also have private insurance coverage at some time during the same year.
Medicaid is supposed to be the payer of last resort, and the claim should go first to a private insurer, if any. But if the person obtaining the prescription at the drug store simply presents his or her Medicaid card, the state pays for it. Then the state tries to collect the cost from the private insurer, a scenario known as “pay and chase.”
Such collections are difficult and time-consuming, and GAO estimated that states are losing at least $238 million a year in overall medical benefits they should not be paying. That figure was based on a survey of 39 states.
“This program could eventually eliminate the need for ‘pay and chase’ pharmacy recovery programs in all state Medicaid programs,” J.P. Little, chief operating officer at RxHub, said in a statement.
Tom Groom, senior vice president of business development at RxHub, said the program’s advantage is that it lets states avoid costs before they are incurred. He said the pay-and-chase recovery rate often is around 3 percent.
He said the two companies hope to have the program running in one or two states by the end of the year.
From the battlefield to the home front: Managing medical data
Government Health IT presents Col. Claude Hines Jr., program manager for the Defense Health Information Management System, in this recent InSight eSeminar. Col. Hines discusses the health information technology and tactical challenges faced by the military medical community in Iraq, Afghanistan and other areas of conflict. In doing so, he describes the current information technology solutions for transferring clinical data between battlefield care givers to health care personnel at military treatment facilities worldwide.
