Data files are obtained from private and public health insurance entities. Each identifies its subscribers or health care participants to TDH by name, Social Security number, date of birth, and other identifying information, all of which can be used to look for matches in the Medicaid claims payment system. The contractor reviews a test tape from each insurer. Upon acceptance of the test tape, the insurer provides a full production tape of participant information and the contractor conducts a data match between the Medicaid and the insurer eligibility files. Compensation provided to insurers for these data tapes varies depending on the frequency of update, size of the insurer, accuracy of the data, and other factors.
Insurers submit updated eligibility tapes as often as monthly or as infrequently as once a year.
The size of the insurers ranges from a few thousand recipients to as many as 2 million. Another factor that can influence the financial arrangement with the insurer is whether or not the insurer can accept claims for identified policies electronically. Data accuracy varies. Some insurers work on data files to provide data that is at least 90 to 95 percent accurate. This level of accuracy is usually accompanied by an agreement that the insurer will not be burdened with a large number of phone calls from the third-party contractor and TDH to verify information on the tape.