Our Solutions

HMS’s commitment to addressing the needs of healthcare payers has resulted in a robust suite of services designed to help them contain costs and increase operational efficiency.

Overall, our services help to make the healthcare system better by improving access, impacting outcomes, containing costs, recovering dollars, and creating efficiencies.

Accordingly, HMS’s services include the following areas:


Did you know … ?

CMS recently selected HMS as a Medicaid Integrity audit contractor under the Medicaid Integrity Program.

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We give you TPL information just in time, when you need it: At enrollment, at re-determination, at point of service, and in claims review.

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We have formal Data Use Agreements with national and state carriers, authorizing us to use their data. We're a trusted steward of that data.

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When it comes to cost avoidance, HMS has the most comprehensive approach available on the market.

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In a 3 month period, HMS recovered over $5 million for New York State through Payment Integrity initiatives, reviewed over $80 million in potential Medicaid overpayments relating to billing errors and under-reported third party payments.

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CMS recently selected HMS as a Medicaid Integrity audit contractor under the Medicaid Integrity Program.

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Our case management system is the only one designed specifically to support Medicaid subrogation.

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Every year, HMS recovers over $1 billion for our clients and saves them billions of dollars more.

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We verify over 2.3 million insurance policies each month.

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In a recent head-to-head comparison performed by the State of Indiana, HMS identified 3 times as many insurance policies as the next best vendor and 6 times as many active policies as the next vendor. And we were able to do so with 95% accuracy.

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We have over 500 physicians, 300 RNs, coders and pharmacists and experts in DME and dental on staff.

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Our National Eligibility Database includes eligibility data from well over 1,000 plans, including TPAs and PBMs.

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We have formal Data Use Agreements with national and state carriers, authorizing us to use their data. We’re a trusted steward of that data.

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Working with so many government programs helps us see the big picture and allows clients to benefit from our knowledge and expertise.

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Only HMS's single-door, program integrity solution offers a comprehensive approach to identify overpayments, increase recoveries, and prevent future overpayments.

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We submit 90% of claims electronically.

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We provide only verified policies to our clients. We supplement 270/271s with other verification processes, including through the Web and live person-to-person telephone contact. We perform over 350,000 voice verifications a month.

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HMS pioneered Third Party Recovery and Cost Avoidance services for Medicaid agencies in 1984.

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In 2009, HMS was awarded the first-ever TPL contracts by Medicaid programs in Mississippi and Minnesota.

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Our eligibility data is refreshed daily.

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HMS is the only independent vendor with a web-based multi-state HIPP system.

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HMS invests over $50 million in cost containment technology annually.

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HMS is URAC Accredited for both Utilization Management and Independent Review

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