Medicaid Reclamation
Medicaid is the payer of last resort. Where another payer was liable and Medicaid paid, the state recovers: reclamation. The accuracy of that recovery depends on the coverage data behind it.
Recovery Quality Is Data Quality
A reclamation program is only as good as its coverage identification. Miss coverage and the recovery does not happen. Assert coverage that was not actually primary and you generate a dispute, a reversal, and provider abrasion.
Both failure modes are expensive and only one of them is visible in the recovery number, which is why recovery rate alone is a misleading metric for a reclamation program.
Neutrality and Connected Workflows
Neutrality Matters Here
Much of the reclamation market operates on contingency: the vendor takes a percentage of what it recovers. That model creates a structural incentive toward aggressive assertion, because a wrong assertion costs the vendor nothing and a missed one costs it revenue. PNT does not take a contingency cut of recovery. The incentive is to identify coverage accurately.
Where It Connects
Reclamation, coverage discovery, and coordination of benefits are the same data problem observed at three points in time: before the claim, at the claim, and after the payment. Programs that treat them as three vendors get three inconsistent answers. State-specific reclamation requirements vary and are handled per engagement.
Frequently Asked Questions
What is Medicaid reclamation?
The process by which a state Medicaid agency recovers payments it made where a third party was liable. Medicaid is the payer of last resort, so where other coverage existed and Medicaid paid, the state has a recovery right. Accuracy depends on coverage identification and COB data quality.
Why does contingency pricing create a problem in reclamation?
Because a vendor paid a percentage of recoveries has no cost for a wrong assertion and lost revenue for a missed one. That asymmetry biases toward aggressive assertion, which produces disputes, reversals, and provider abrasion, costs that do not appear in the recovery number the vendor is measured on.
How are reclamation, coverage discovery, and COB related?
They are the same data problem at three points in time: before the claim (discovery), at the claim (COB), and after the payment (reclamation). Treating them as three separate programs with three vendors reliably produces three inconsistent answers about the same member.
Workflows and Industries
Coverage Discovery
Identify active insurance a provider has no record of, after self-pay registration, incomplete demographics or an unresolvable AAA 72 rejection.
Coordination of Benefits
Determine which payer pays first when a member has more than one coverage, including the separate Medicare Secondary Payer rules.
Government Programs
Medicaid, CHIP and government health program data exchange from a verified SDVOSB.
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