Michigan Department of Health and Human Services

Third Party Liability Electronic Database (TED)

Helping the State of Michigan recover hundreds of millions for Medicaid.

Project details

Client: Michigan Department of Health and Human Services

Service provided: Custom software development, maintenance & support, enhancements

Status: Completed & live. On-going maintenance, support & enhancements

Technologies: Java (Spring MVC), Oracle PL/SQL

Background information

The State of Michigan’s Medicaid program provides healthcare coverage to low-income individuals and is administered by the Michigan Department of Health and Human Services (MDHHS). In accordance with federal law and regulations, MDHHS ensures that Medicaid beneficiaries utilize any other available resources to cover their medical expenses before relying on Medicaid and, therefore, only pays for those costs after other parties have fulfilled their legal obligation to pay. The state seeks to recover payments made by Medicaid for claims that should have been covered by another payer. The MDHHS’s Third Party Liability (TPL) Division is responsible for pursuing reimbursement of Medicaid expenses that are the responsibility of other parties.

Prior to 2010, the TPL division of MDHHS used two systems to track post-payment recovery and paternity and casualty recovery activities—the Post Payment Recovery System (PPRS) and the Paternity and Casualty Recovery System (PCRS). Sourcing leads for these activities required a lot of manual leg work which was time-consuming and allowed potential leads to go undetected. Furthermore, working a lead to recovery can be a long process requiring lots of touch points and even litigation, necessitating a system to keep these activities organized and alerting TPL personnel to upcoming and overdue work. Working in two systems created inefficiencies, such as duplication of work. The aging technology limited functional capabilities, had more security vulnerabilities, and was reaching end-of-life with regard to support.

In 2010, KL&A was contracted to consolidate these systems, modernize the technology, and implement new functionality to improve TPL efficiency and effectiveness.

Project details

Client: Michigan Department of Health and Human Services

Service provided: Custom software development, maintenance & support, enhancements

Status: Completed & live. On-going maintenance, support & enhancements

Technologies: Java (Spring MVC), Oracle PL/SQL

System overview

The TPL Electronic Database (TED) system is an enterprise web application used to manage recovery activities for the State of Michigan Medicaid program due to third-party liability (TPL). Recoveries may be obtained through court cases handled by the Legal Liability Section or through billing activities to commercial health or pharmacy payers. TED is comprised of the following main modules:

  • Coverage lead identification / cost avoidance
  • Health recovery
  • Legal liability case management
  • Injury accident questionnaires
  • Accounting reconciliation
  • Vendor management
  • Medicare buy-in
  • System administration and reporting

This system has evolved continuously since 2005, with two modernization efforts and on-going enhancements to improve business efficiency.

System features:

  • Web-based, responsive design
  • Dashboards, work queues, and assignment capabilities
  • Case management
  • Data mining for recovery opportunities
  • Dynamic reporting
  • Correspondence generation
  • Document management
  • Group and role-based security
  • Single Sign-On (SSO)
  • 100+ system integrations

System features:

  • Web-based, responsive design
  • Dashboards, work queues, and assignment capabilities
  • Case management
  • Data mining for recovery opportunities
  • Dynamic reporting
  • Correspondence generation
  • Document management
  • Group and role-based security
  • Single Sign-On (SSO)
  • 100+ system integrations

Services provided:

  • Complete project management services
  • Full Agile SDLC activities
  • Business process reengineering
  • Requirements definition
  • Design and development
  • Testing and implementation
  • End-user training and documentation
  • Maintenance and enhancements

Results obtained:

  • TED has helped the state save and recover over a billion dollars since 2006.
  • TED has increased the state’s ability to help Medicaid recipients by returning funds to the program.
  • TED prevents improper payment of claims, avoiding recovery related costs.
  • TED has helped Michigan have the most advanced TPL operation in the nation.
  • TED ensures the division can efficiently identify and process thousands of cases a year.
  • TED has automated and streamlined TPL processes, saving thousands of hours in manual labor.

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