HMS has a variety of case management services for revenue recovery and cost containment. Our services can be applied retroactively to recover payments (such as those tied to casualty or estate cases), or proactively (such as HIPP or Buy-In projects).
HMS provides Casualty Identification and Recovery Services for a number of payors. Our team identifies and recovers expenditures for members that were injured through the willful or negligent action of another party. HMS provides rapid case identification through referrals and data matches, effective communication with stakeholders (including providers, attorneys, insurers), and efficient case management up to and including negotiating settlements. On behalf of Medicaid agencies, in particular, the depth of HMS’s experience can help Medicaid minimize the impact of the Ahlborn Decision on recoveries.
For Medicaid agencies exclusively, HMS’s Estate Recovery Services identify and recover Medicaid expenditures from the estates of deceased Medicaid members in accordance with each state’s unique policies. HMS addresses the many complex issues that affect estate recovery initiatives, including: (i) the necessity for political and legislative support, (ii) the need to integrate disparate data sources, including probate and property ownership and tax data, (iii) the labor-intensive effort required to develop cases and file and pursue claims, and (iv) the complexity of state probate laws. Our trained team of caseworkers and legal professionals work collaboratively with stakeholders to streamline the process and protect Medicaid’s interests.
Systems
HMS caseworkers rely on Maestro, our proprietary, rules-driven subrogation recovery system, to manage casualty and estate recovery cases. This fully integrated system facilitates all aspects of case management, including creating correspondence, tracking case activity, importing and exporting case data (including claims), and prioritizing cases.
Maestro can also be deployed as a standalone system. Given that it was designed from the ground up to address casualty and estate case management processes, Maestro’s functionality can offer a powerful system solution that supports state caseworkers and helps them effectively manage their subrogation activities. 
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.
