Medicaid Data Review : Department of Public Health And Human Services 2007

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Our goal was to identify Medicaid recipients who are covered by a TPL but not identified as such. We did not have access to Blue Cross and Blue Shield or New West Health records, but we were able to obtain the records for all individuals who are covered by Blue Cross and Blue Shield or New West Health through the state healthcare plan (plan). We compared the plan enrollment records with records of Medicaid recipients.
As of March 2007, we identified 244 individuals who are covered by Medicaid a
...nd the state health care plan, but only identified as having Medicaid in the MMIS. Between March 1, 2006 and February 28, 2007, the Medicaid program paid 12,183 claims totaling $3,913,095 to these individuals. Of this $3.9 million, at least a portion may have been covered through the state healthcare plan.
It is important to note that the population we tested was from a single insurance plan representing a small percentage of private insurance membership in the state.
Medicare Responsibility Medicare is another entity responsible for paying health care costs before Medicaid.


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