This measure is important because maintaining accurate commercial insurance information ensures that Medicaid is the payer of last resort, by requiring the other insurance company be billed as the primary insurance for the services received by the member.

The Member and Provider Services (MPS) Unit’s Third-Party Liability (TPL) Team completes the data matching files by comparing the data of the insurer’s eligibles to Medicaid eligibles. When a member on the insurer’s data file is also Medicaid eligible; insurance information is added or updated in the member’s case in the Medicaid systems. This ensures that providers bill the claims to the primary insurance before billing Medicaid. If claims are received for a Medicaid eligible with other insurance on our system, the providers are directed to bill the other insurance for the services before Medicaid can be billed. The TPL Team currently only receives monthly files from insurer Blue Cross Blue Shield of Vermont.

In March of 2024, there was an error in the file transfer for the BCBS of VT data match. This error resulted in many more discrepancies and duplicates than normal, which all were put into ACCESS system in error. The MPS team has addressed and fixed the issue In June of 2024 through 2 months of working with Gainwell, the file transfer with BCBS VT data matching was corrected. The April file was re-run and added into the ACCESS system. When trying to re-run May’s report, another issue was identified, which required further investigating with Gainwell. In early July the May and June file were re-run and were loaded into ACCESS system together. June 2024 data matching numbers include both May and June 2024 data. As of today, BCBS VT PIE data matching is working accurately and back to current. 
 

Narrative last updated:  08/14/24

• Blue Cross Blue Shield of Vermont (BCBSVT)

In SFY24, the new automation process known as COB OnDemand will be implemented. 

COB OnDemand will deliver enrollment files on daily rather than monthly basis.  Once implemented, DVHA will outreach other insurance companies and encourage participation in the new COB OnDemand process.