The 1990s have brought sweeping changes to Texas' health care marketplace that significantly affect Medicaid third-party identification and recovery. This focus has revealed several issues that require special attention to ensure the continued success of Texas Medicaid third-party identification and recovery operations. Again, many health insurance entities subcontract certain services to companies specializing in claims processing for specific services, most notably dental and prescription drug services. Since these data matches have not been conducted, millions of dollars in potential Medicaid recoveries are being lost. Critical billing information needed Current law requires insurers to provide the state's Medicaid third-party recovery contractors with a name, employer's mailing address, Social Security number, and date of birth for each covered subscriber or policyholder.
Few carriers provide all of the information requested.
Most submit the minimum data elements necessary to conduct a valid data match. To make a claim in the most cost-effective way, TDH needs additional information including the claim submission address, group policy number, and names and dates of birth of covered dependents. Without such information, extensive manual verification is necessary, requiring additional time and expense for both TDH and the insurer providing the data tapes. In addition, given the turbulent health care market, insurers themselves often change ownership or name over the year. No penalties for noncompliance State law governing Medicaid data matches does not specify any penalty for noncompliance.