Medicare Secondary Payer (MSP) data is one of the most persistent sources of missed revenue for Medicare Advantage (MA) plans. For Medicare finance teams, inaccurate MSP data translates directly to lost premium revenue. For program integrity teams, it leads to preventable claim overpayments. Despite this, many organizations lack clear visibility into how accurate their MSP data actually is, or how much opportunity remains.
Even plans with strong internal teams and established vendor relationships are leaving premium dollars on the table. The longer inaccurate MSP data goes uncorrected, the further restorable premium slips out of reach. Dollars that could be realized this year are pushed into the next, and some are never restored at all.
Timely recovery drives revenue faster than most plans realize. Machinify reaches speed to value in about 45 days from data receipt, so premium is restored in-year rather than the next cycle.
Where mature programs consistently fall short
Using machine learning and rigorous data validation, Machinify restored more than $47 million in premium across three MA plans that prior efforts had missed. Each plan had already been running MSP programs for years. They had internal teams, defined workflows, and in some cases, partnerships with other vendors. Yet the same patterns showed up across all of them.
Performance had plateaued. Restoration totals were no longer improving in a meaningful way. Results often grew with membership instead of improving through better accuracy or deeper analysis.
Visibility was limited. Teams could not clearly quantify how accurate their MSP data was or how much opportunity remained. Reporting focused on what had been restored, not what had been missed.
Processes leaned heavily on automation. Standard data sources were treated as reliable even though they contained a high rate of errors and stale records. Without consistent validation, gaps persisted.
Confidence became a barrier. Many teams believed they had already captured most of the opportunity or were performing well enough relative to peers.
The results were similar across organizations of all sizes. Smaller regional plans uncovered significant value when they conducted a comprehensive historical review for the first time. Large national payers with mature programs continued to see meaningful improvement after years of investment.
Three plans, three different starting points
When “good enough” is not enough
A large national MA plan had a mature, well-resourced setup with a strong internal team, a partnership with an established vendor, and years of program maturity. On paper, there was little reason to expect more.
A second-pass review told a different story. In the first year alone, Machinify restored more than $20M in premium on opportunities the existing efforts had missed. Even with strong internal and external resources in place, first-pass processes struggled with incomplete data and harder-to-validate cases.
The first comprehensive historical review
In a different example, a regional health plan had handled MSP premium restoration internally for years. They had restored $35M on their own, a strong outcome by any standard.
Still, Machinify found more than $17M in additional premium in the first year, on top of what the plan had already captured. This suggests that even well-functioning programs may be leaving dollars on the table. Comprehensive historical reviews often uncover years of compounded opportunity, especially for smaller plans.
Speed and scale in a time-sensitive environment
Another large national payer faced a different constraint. They had a long-standing MSP vendor across a population of roughly one million MA lives, but results had plateaued. With year-end approaching, they needed measurable impact within months.
A focused engagement delivered more than $10M in restored premium within the first 90 days, with implementation completed in about 30—well within their year-end deadline. Across two quarters, total restored premium reached $20M on cases the first-pass vendor had missed.
The program expanded quickly after that. Machinify was promoted to first-pass vendor, growing from a targeted engagement into a broader role across their contracts.
In each of these cases, the change was not incremental. It began when the plan engaged Machinify and applied a more rigorous approach to identifying and restoring MSP-related premium.
What health plans should take away
Even plans with established MSP programs may not be operating at full capture. Each of these organizations had already invested in internal resources, external vendors, or both, yet still uncovered additional premiums when they took a closer look.
Data quality drives outcomes
When MSP data is inaccurate or stale, restoration efforts miss cases. Without consistent validation, even well-designed processes leave opportunities behind.
Speed supports in-year impact
Plans that move quickly can realize results within the same year, while delays push restoration further out. In one case, more than $10M was restored within 90 days, supported by an implementation timeline under 30 days.
Fits into what's already in place
Programs that operate alongside existing teams and vendors are easier to adopt, since they do not require a full reset of current processes. That makes it more practical for organizations to act on the opportunity without slowing down what is already in place.
Plans of all sizes can benefit
A regional plan uncovered significant value after its first comprehensive review, while large national plans with mature programs still identified gaps. The difference came down to the quality of the data and the rigor of the process, not the scale of the organization.
The Machinify advantage
Having an MSP premium restoration program in place is not an automatic fix. Changes in member data, assumptions about completeness, and emerging edge cases can contribute to lost premium if continuous validation is not in place.
In several cases, Machinify has come in behind incumbent vendors with majority market share and uncovered substantial additional value. That track record reflects both technical capability and the ability to identify opportunities that other approaches miss.
Machinify offers a no-obligation MSP opportunity assessment to quantify your plan’s premium restoration potential based on your historical data, contract structure, and current processes.
Our approach includes a 6-year historical lookback window, the maximum allowed under CMS guidelines, ensuring plans capture the full range of restorable premium.
Contact us to request your personalized assessment to see what you might be missing.
Michael Feid is the Senior Vice President of Eligibility and Recovery Services at Machinify. He has 20 years of healthcare experience with progressively responsible roles and a history of leading successful payment integrity programs for COB, Medicare Secondary Payer, §111 reporting, data mining, and eligibility management. His experience includes leveraging operational, process-oriented expertise to transform client implementations and program delivery into accelerated growth and revenue while ensuring a positive client experience.
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