CASE STUDY 5
INSURANCE DISCOVERY
Client:
13,156 accounts with Medi-Cal indicated as the payer
Challenges:
- Determining if other payers are primary
- Identifying MCOs, IPAs and / or Medical Groups on policies
- Correcting incorrect patient first names, last names and dates of birth
- Identifying coverage for incorrect Medi-Cal member IDs
- Accelerating delivery of accurate information for proper claim submission
Results:
- 965 rows had incorrect Medi-Cal member IDs that did not conform to the Medi-Cal member ID convention. Our Demographics Enabler was able to utilize 617 of the 965 rows. We returned 465 rows with active coverage.
- Uncovered Managed Care Organizations and / or IPAs and Medical Groups for Medi-Cal with 8,397 rows of which all have active coverage.
- We identified SSNs for 9,491 rows and corrected 2,915 rows with names and / or dates of birth, both of which contributed to 10,959 total rows in the file with active results.
- 1,235 accounts were outside of the date of service range to check Medi-Cal eligibility. The payer responded as follows: “Enter an as of date up to 12 months in the past and to the end of the current month.”