Ohio Mandates Algorithmic Insurance Checks for Medicaid Payments

The regulatory pressure stems from the One Big Beautiful Bill Act, which demands that states keep improper payment rates below 3% by fiscal year 2030. Federal PERM audits track these errors at the moment of adjudication, meaning that once a claim is paid, the designation of an improper payment is permanent regardless of later recovery. Consequently, traditional post-payment audits no longer satisfy the strict compliance requirements set by federal oversight.

Syrtis Solutions has positioned its ProTPL platform to meet these demands by analyzing eligibility and coverage data in real-time. By identifying active commercial insurance or Medicare coverage at the point of claim, the system prevents Medicaid from acting as the primary payer when other liabilities exist. As states scramble to meet the 3% threshold, this real-time verification has transitioned from a supplemental cost-saving tool to a primary component of federal compliance strategy.