SYRTIS SOLUTIONS AUTOMATED ALGORITHMIC ANALYSIS AND INSURANCE DISCOVERY ENGINE HAS BECOME ESSENTIAL TO MODERN MEDICAID OPERATIONS
Automated algorithmic analysis and insurance discovery engines (AAAIDE) are becoming cornerstones of modern Medicaid operations. By identifying liable third-party coverage at the point of claim adjudication, these technologies reduce improper payments, strengthen payment accuracy, and improve coordination of benefits.
This priority is now reflected in state policy. On June 10, 2026, Ohio passed Senate Bill 315, which requires the Ohio Department of Medicaid to use automated algorithmic analysis and insurance discovery engines before making any Medicaid payment. The measure reflects a broader regulatory shift toward prevention over post-payment recovery.
Under the One Big Beautiful Bill Act (HR1), states must maintain improper payment rates below 3% by federal fiscal year 2030, measured through PERM audits that flag claims where Medicaid was billed as primary despite active third-party coverage. Critically, PERM audits measure compliance at the point of adjudication: once a claim is paid improperly, recovery cannot reverse the improper payment designation. Only point-of-claim insurance discovery prevents both the improper payment and the HR1 compliance risk simultaneously. Traditional post-payment recovery addresses cost but not compliance.
Long before this legislative requirement, Syrtis Solutions was delivering these capabilities to Medicaid managed care organizations nationwide. ProTPL, Syrtis' proprietary platform, continuously analyzes claim-level eligibility and coverage data to identify active commercial insurance, Medicare, and other liable third-party coverage at the point of adjudication, surfacing coverage that traditional monthly or quarterly eligibility files miss entirely.
This point-of-claim approach improves coordination of benefits, supports cost avoidance initiatives, and directly addresses PERM audit compliance. As Medicaid programs face HR1 improper payment standards and deadline pressure, real-time insurance discovery has become essential to compliance strategy.
About Syrtis Solutions: Syrtis Solutions provides insurance discovery, coordination of benefits, and payment integrity solutions for Medicaid agencies and Medicaid managed care organizations. Through ProTPL, Syrtis helps clients identify previously unknown commercial coverage, optimize third-party liability routing, and support PERM compliance while helping clients meet Medicaid's payer-of-last-resort requirements.
For more information, contact: Steve Konsin, Jr. 866-960-9358 [email protected] www.syrtissolutions.com
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