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Monday, March 18 • 1:00pm - 2:30pm
Track 4 (Workshop): Third-Party Coverage: How Verifying Coverage Pre-Billing Saves Money and Creates Efficiencies for Providers and Payers Alike

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Millions of dollars each year are lost due to lack of information about liable third-party payers. For Medicaid alone, the cost of improperly paid claims climbed to more than $18 billion in 2016 – an increase of nearly $4 billion in three years. More than half of these improper claims were due to incorrect billing from providers who often don’t have updated coverage information especially when Medicaid recipients have access to other health coverage at the point of service. Join us for this session on how HMS piloted a new solution – along with an Ohio hospital provider and Ohio Medicaid – to improve coordination between Medicaid agencies and providers by allowing them to verify and communicate other primary coverage for Medicaid members prior to billing – even at the point of scheduling, admissions and authorization.   

avatar for Patrick Tighe

Patrick Tighe

Bureau Chief Claims Operations, Ohio Department of Medicaid
Patrick A. Tighe is the Bureau Chief of Claims Operations with the Ohio Department of Medicaid.  He is responsible for the Claims Processing, Claims Reconciliation, Medicare Buy-In unit, Third Party Liability and the Cost Avoidance areas as well as the Contract Manager for Third... Read More →
avatar for Deb Grier

Deb Grier

VP Enterprise Product Management, HMS
Deborah Grier, HMS Vice President COB Product Strategy, has over eighteen years of experience in healthcare program management and product development. Her career has been focused on developing solutions for government-funded health and human services programs, including working with... Read More →

Monday March 18, 2019 1:00pm - 2:30pm PDT
Key Ballroom 10 (2nd Floor)