The Quick-Start Guide to Selecting the Best Medicaid Third Party Liability Vendor

By Eric Hallemeier
Aug. 10, 2016

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Selecting the right Medicaid third party liability (TPL) vendor matters.

Why? Because if you pick the wrong one – say a vendor who doesn’t offer all the services you need or has limited experience in Medicaid – you risk wasting a lot of time and complicating an already complicated process. And nobody wants to do that.

Including HMS. Which is why we created this list of things for state agencies to look for when selecting a TPL vendor. We hope it helps.

Fast and thorough.
Your vendor should able to identify an individual’s coverage quickly and thoroughly. A simple search doesn’t always tell the whole story. Look for a vendor with a quality robust match system in place that allows it track down all existent coverage – more than a 95% match between your member data and the vendor’s eligibility data.

Dedicated to quality data.
Quality data is the best way to minimize negative outcomes in the Medicaid third party liability process, so make quality data a priority. Hire a vendor with a dedicated management team focused on data quality.

Stores data securely.
Data needs to being stored in a secure environment. Strong firewalls, encryption, and digital acknowledgement of sent and received files are a few of the ways a vendor can ensure security. Look for third-party security certifications, such as HITRUST.

Capable of flexibility.
Maybe you need medical, dental, and pharmacy information? Or maybe you need something slightly more specific? Either way, it’s important to find a TPL vendor capable of adapting its findings to suit your state’s specific needs.

Full service.
Be sure the vendor you select offers a full array of services – such as cost avoidance and a variety of recovery options – with proven outcomes. Whatever comes up, a vendor should be capable of changing an order to find specific information.

Technologically sound.
Technology is constantly evolving and the same should apply to your vendor. By using the most efficient technology available, your vendor will remain up-to-date enough to process agreements and anything else that comes its way.

Prepared for unknowns.
Your vendor should have a dedicated carrier relationship team; it’s easy to miss information if you’re not looking for it. Providing a dedicated team maintains a dialogue so that any unusual or negative information gets noticed early.

Focus on denial analysis.
A TPL vendor should attempt to gain the most value for your claims via denial analysis. Some denials are actionable. Your vendor should provide a team focused specifically on claims denied by a carrier.

Experts in the field.
Experience is important, especially with such a nuanced and complex subject matter. The more experience and knowledge your TPL vendor has, more valuable it will be to you.

Find out why HMS is America’s preeminent Medicaid third party liability provider – and your state agency’s best partner to maintain the strongest plan.


Eric Hallemeier is Sr. Director of Product Strategy for HMS.

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