Vendor Oversight
Develop data-driven insights with oversight on all your third party liability related efforts.
Seeing is believing.
Overseeing all aspects of your Medicaid third party liability (TPL) efforts is vital to maximizing recovery potential whether you’re completely outsourcing the work to multiple vendors, collaborating between your staff and vendors, or managing everything in house. In the context of state TPL divisions overseeing Medicaid recovery efforts, when that work is contracted out it can leave you in the dark for any information until the money starts arriving. Imagine how much more efficient your team could be by proactively improving processes with all the information in a claim life cycle in real time at your fingertips.
From the big picture of how much money is being recovered to seeing all the details of how rejections are being handled, we offer a vendor oversight solution like no other. A robust vendor oversight solution provides state TPL staff with transparency, accountability, and management of the recovery process. It streamlines the management of multiple vendors, reduces manual tracking and administrative burden, and helps ensure compliance with state Medicaid regulations and the Centers for Medicare & Medicaid Services’ (CMS) requirements.
We understand the importance of transparency and accountability in managing Medicaid recovery efforts. But we’re not all talk. Using our modular solutions makes us one of your vendors – so you’ll have access to oversee any recovery related services we provide to you from our modular solution offerings.
Allow us to open your eyes to the possibilities.
Our effective vendor oversight solution allows state TPL divisions to have visibility into the recovery activities of all vendors, including in-house teams, from a centralized dashboard. It involves tracking vendor performance, verifying claim statuses, reviewing payments, monitoring communication, and more. KL&A’s TPL experts leverage our existing base technologies to design a customized solution tailored to your specific vendors and unique needs. This will enable your staff to identify any issues or areas that require improvement, make informed decisions based on real-time data and analytics, and optimize recovery efforts to achieve maximum results.
Dashboard & Report Monitoring
Oversee all of your recovery-related efforts for Medicaid TPL from any and all vendors, including your in-house teams, with ease. Our user-friendly platform provides a unified dashboard that gives you a comprehensive view of all your recovery activities in one place.
- Conveniently monitor performance, including: how much is being recovered, how many claims are pursued, how long recoveries take, what coverage is being used, how rejections are handled, and more.
- Access the most accurate and up-to-date data, empowering you to make informed decisions and optimize your recovery efforts for maximum results.
- Our robust reporting features allow you to identify trends and generate customized reports that provide actionable insights.
- Keep TPL leadership and your team updated with informative visuals to communicate key information and recovery results.
- Our experts can also help you leverage even a small in house team with strategic planning to identify key payers in your state and optimize your focus on where you can maximize the most recoveries.
Dashboard & Report Monitoring
Oversee all of your recovery-related efforts for Medicaid TPL from any and all vendors, including your in-house teams, with ease. Our user-friendly platform provides a unified dashboard that gives you a comprehensive view of all your recovery activities in one place.
- Conveniently monitor performance, including: how much is being recovered, how many claims are pursued, how long recoveries take, what coverage is being used, how rejections are handled, and more.
- Access the most accurate and up-to-date data, empowering you to make informed decisions and optimize your recovery efforts for maximum results.
- Our robust reporting features allow you to identify trends and generate customized reports that provide actionable insights.
- Keep TPL leadership and your team updated with informative visuals to communicate key information and recovery results.
- Our experts can also help you leverage even a small in house team with strategic planning to identify key payers in your state and optimize your focus on where you can maximize the most recoveries.
Coverage Review Process
Having accurate coverage to perform efficient cost avoidance is no doubt the most effective TPL recovery strategy. We know that keeping coverage up to date can be challenging depending on your TPL journey. Vendors may be a cost-effective supplement for these efforts, but they can only do so much. When it comes to large data volumes, auditing for accuracy and completion is crucial.
- No more manual checking and re-checking. Take advantage of our cutting-edge automated rules that can be tailored to your program’s definition of completeness.
- Take the guesswork out of coverage matching by effortlessly cross-checking submitted coverage against your existing MMIS data, ensuring complete accuracy at all times.
- With our custom review workflows, you can streamline your data review process like never before – and by including various submission categories, we’ll provide you with a comprehensive overview of all your data.
- Gain the upper hand in contract negotiations with our advanced platform that allows you to easily review acceptance and rejection trends, enabling you to drive discussions on terms and help you secure better contracts.
- Say goodbye to duplicate payments. Keep your finances in check with complete tracking of invoicing to ensure that you are only paying for the coverage you agreed to.
Subrogation Review Process
Performing electronic subrogation in-house brings the most value, but we know it isn’t always cost-effective for states to take all that work on if you don’t have the resources. Even if you’re in a transitional period of bringing payers in house or dealing with payers that are stuck in the past still using paper, it’s important to ensure your vendors are providing insights into their process and tracking their progress. Our comprehensive vendor module does just that.
- Unlock the full potential of your claim subrogation process with our comprehensive data-sharing capabilities! Our platform mandates data sharing from vendors, allowing you to gain valuable insights into every aspect of the claim subrogation lifecycle.
- Minimize information discrepancies and ensure your data accuracy by cross-referencing submitted coverage by vendors against their subrogation efforts.
- Prevent information overloads by identifying and targeting claims the vendor should prioritize – keeping the amount of data shared to the absolute minimum to ensure HIPAA compliance.
- Take control of your recovery payments. Create and customize your own rules to accept or deny vendor recoveries based on contract terms and stipulations.
- Say goodbye to the headache of tracking accounting information and worrying about compliance during audits. With our innovative technology, you can effortlessly reconcile your invoicing directly against your recovered claims, ensuring accurate and streamlined financial management.
Subrogation Review Process
Performing electronic subrogation in-house brings the most value, but we know it isn’t always cost-effective for states to take all that work on if you don’t have the resources. Even if you’re in a transitional period of bringing payers in house or dealing with payers that are stuck in the past still using paper, it’s important to ensure your vendors are providing insights into their process and tracking their progress. Our comprehensive vendor module does just that.
- Unlock the full potential of your claim subrogation process with our comprehensive data-sharing capabilities! Our platform mandates data sharing from vendors, allowing you to gain valuable insights into every aspect of the claim subrogation lifecycle.
- Minimize information discrepancies and ensure your data accuracy by cross-referencing submitted coverage by vendors against their subrogation efforts.
- Prevent information overloads by identifying and targeting claims the vendor should prioritize – keeping the amount of data shared to the absolute minimum to ensure HIPAA compliance.
- Take control of your recovery payments. Create and customize your own rules to accept or deny vendor recoveries based on contract terms and stipulations.
- Say goodbye to the headache of tracking accounting information and worrying about compliance during audits. With our innovative technology, you can effortlessly reconcile your invoicing directly against your recovered claims, ensuring accurate and streamlined financial management.
So let’s get proactive!
Our comprehensive vendor oversight solution empowers state TPL staff with data and insights to effectively oversee vendors and their own efforts to drive successful Medicaid recovery efforts. With a custom configuration to suit your needs, we’ll create a seamless and intuitive solution that puts you in control of your Medicaid recovery efforts like never before.
Cost Optimization
By analyzing vendor performance and recovery activities, state TPL staff can identify areas where costs can be optimized, such as reducing unnecessary or redundant activities, streamlining processes, or renegotiating contracts with vendors.
Enhanced Vendor Relationships
State TPL staff can track vendor performance, provide feedback, and address issues in a timely manner. This helps build stronger vendor relationships, ensure vendors meet their obligations, and drive better vendor outcomes.
Compliance and Risk Management
By monitoring vendors’ activities, state TPL staff can identify any potential compliance risks or issues and take proactive measures to mitigate them. This helps in avoiding potential penalties, protecting sensitive data, and maintaining compliance with regulatory requirements
Transparency and Accountability
With a comprehensive view of all recovery activities from multiple vendors, including in-house teams, state TPL staff can monitor performance, track progress, and access detailed reports that provide insights into recovery efforts. This transparency holds all partners accountable for their performance and allows your team to better understand the impact of their efforts.
Identify Trends and Patterns
By analyzing all this data, state Medicaid TPL teams can uncover patterns of claim denials, identify common issues, and pinpoint areas that may require further investigation or improvement. This helps in developing strategies to address recurring issues, optimize processes, and better understand what your vendor is doing for the potential to bring some recovery efforts in house.
Data-Driven Decision Making
Our oversight solution provides real-time data and analytics that allow state TPL staff to make informed decisions based on accurate and up-to-date information. This helps identify areas that may require improvement, optimize recovery efforts, and drive better results.
But don’t stop here.
Let’s get even more proactive to optimize all of your TPL processes! There’s much more to subrogation and coverage than just oversight and planning. See how our related modules can help create a flexible configuration of solutions to help maximize your recovery potential.
MANAGED CARE SUBROGATION & OVERSIGHT
See how you can further improve vendor relationships with your Managed Care Organizations with more oversight modules – or let us help your subrogation efforts if you are an MCO in need of service.
HEALTH SUBROGATION
Streamline your entire billing and claim recovery process. Explore our service modules that allow us to serve as your fiscal agent or help you work more efficiently no matter how big or small your team is.
Feeling lost in a black box with your vendors?
Allow us to shed some light with our oversight modules.