HMS understands the importance of accurate, timely cost avoidance data for healthcare programs. By discovering new coverage information, HMS clients avoid paying future claims, resulting in savings worth many times the value of payments recovered retroactively through typical "pay and chase" activities. At the same time, when applied during the Medicaid or CHIP enrollment process, programs can accommodate this other coverage in the individual’s profile, or cover only those individuals who meet qualifying criteria.
Relying on our Other Coverage Identification matching process described earlier, HMS is able to verify other coverage and develop a complete policy profile for our clients. Using our suite of verification tools, we verify coverage directly with the carrier in order to develop a complete policy profile according to our client’s specific requirements. /our tools include ANSI 270/271 transactions, automated web agents, and telephone outreach, all of which we use in concert with one another to return reliable information to our clients as quickly as possible—including in real-time.
Equipped with this information, our clients can use it to correctly coordinate benefits and redirect claims to a liable third party payor. For example, Medicaid agencies and their contracted managed care plans can ensure that they remain the "payor of last resort" and avoid paying for services for which another party is legally liable.
As the national leader in cost avoidance, HMS verifies over 2.3 million insurance policies each year, resulting in billions of dollars in savings annually to our clients. 
Working with so many government programs helps us see the big picture and allows clients to benefit from our knowledge and expertise.
