Third-Party Liability

Center identifies benefits, coordinates claims, and more

Unraveling the mysteries of Medicare and other agencies and programs is not easy. But when successful, the quest can reap huge dividends for state coffers.

This is the core of third-party liability — assuring that the state Medicaid program is the payer of last resort by effectively pursuing payment from other entities for services provided to Medicaid recipients. Regardless of the size of a state Medicaid program, Medicare is always the largest single source of these payments.

UMass Medical School’s Center for Health Care Financing employs recognized third-party liability experts with strong academic credentials, legal backgrounds, and professional experience in state and federal government agencies. The Center’s multidisciplinary consultants, with their financial, legal, and clinical knowledge, address these challenges:

• Benefit Identification
  Center experts identify other payers, in addition to Medicaid, that are responsible for benefits.
• Casualty and Estate Recovery
  The Center recovers Medicaid dollars from liable parties for injuries due to accidents and trauma, and also works with courts and other agencies to identify and recover state funds from probated estates.
• Claims Coordination
  Center staff members evaluate the service codes that providers use to bill Medicaid and carry out critical claims adjudication and re-pricing activities based on individual eligibility and third-party insurance coverage.
• Enhanced Coordination of Benefits
  The Center lightens a state’s financial burden by targeting high-cost, medically complex Medicaid members and connecting them with comprehensive benefits, ensuring that other insurers cover their legal liability while sharing the costs of care for this population.
• Medicare and Commercial Identification
  The Center identifies Medicaid members who are qualified for — or already have — other coverage, resolves data disconnects, and performs further investigation as necessary.
• Premium Assistance
  The Center’s staff assists state Medicaid agencies in helping low-income residents purchase employer-sponsored health insurance, which saves millions of dollars each year.