SXC to launch enhanced Coordination of Benefits service in the state Medicaid market

"SXC continues to leverage our proprietary technology to innovate and deliver increased savings to healthcare payers.  This service reflects our ability to utilize data and technology in powerful new ways to enable State Medicaid Programs to stretch their budgets and increase recipient service," said Mark Thierer, Chairman and CEO of SXC.  "We believe that this enhanced COB offering is applicable across many of the markets served by SXC. The impressive early results of this program demonstrate our ongoing commitment to deliver new and innovative applications of data and technology to drive increased efficiency and cost containment."

On average, 13% of all Medicaid beneficiaries have unreported primary coverage, costing states billions of dollars in healthcare costs when, in fact, there was third party liability (TPL).  Pay-and-chase recovery efforts, the standard approach in the industry today, are expensive, inefficient and marginally effective; states typically recoup only 17% of potential claim dollars. SXC identifies these beneficiaries by integrating external data sources, identifying suspect TPL cases and embedding unique algorithms into the claims recovery process.  This offering is architected to run as a stand-alone application and can run independently of the claims processing platform.

With production go-live in July, the enhanced Coordination of Benefits service has already yielded significant client savings, and numerous state Medicaid programs have expressed interest.  With $15.4B in annual Medicaid prescription drug costs, the potential impact of this service for state programs is considerable.