Medicaid Savings Plan Introduced by ACS
A new software initiative introduced by Affiliated Computer Services, Incorporated (ACS) will help State Medicaid programs save millions of dollars every year. The solution prevents the need for Medicaid agencies to complete manual drug recovery claims, which are submitted to commercial insurers. That process can be costly for the agencies, as described in the ACS press release.
The ACS system allows pharmacies to identify pharmacy benefit coverage at the point-of-sale. The SmartPA(SM) authorization solution provides pharmacists with information about patient’s insurance coverage when they present to the pharmacy to fill prescriptions. This is completed in real-time as prescriptions are filled by checking patient’s names in the RxHub Master Patient Index, which includes more than 200 million patient records.
RxHub includes up-to-date information on patient’s prescriptions. Details available include medication history, prescription eligibility, benefits, and formulary. This tool can also help clinicians manage patient medication, including identification of the most cost-effective therapy available.
This new process prevents the processes commonly employed by the State agencies to recover funds in cases where alternative insurance coverage is identified. These other approaches are generally inefficient.
When patients who carry additional commercial coverage are identified by Medicaid agencies, the state must attempt to avoid paying out fees or, alternatively, pay at the time that patients present to the pharmacy and hope to recoup costs from the commercial insurers. Seeking reimbursement from other insurers takes months to complete and agencies often only recoup a small proportion of the monies spent.Commercial insurers are required by federal law to make payments before claims are submitted to Medicaid for individuals who are covered by both types of health insurance. Current systems, which are most commonly paper-based, do not support simple identification of such patients. The systems to retrieve reimbursement from other insurers only yield limited remuneration.
March 18, 2008 Related topics: Finance, Product Launches, New Technology & Innovation