HMS’s Medicaid eligibility screening service enables a state to effectively serve its Medicaid-eligible population by helping to determine if a resident qualifies to receive Medicaid benefits. HMS’s services are all encompassing, and include initial application receipt and review, initial eligibility determination, enrollment processing, and continual communication with program participants via our full service customer call center. Standard to our approach is an exhaustive search for other coverage available to Medicaid applicants, which assists with coordination of benefits issues and helping to ensure that Medicaid remains the payor of last resort right from the beginning.
Our holistic approach includes assisting a state in its efforts to engage additional members through marketing and program outreach, and reporting on the overall performance of the program and related call center operations.
Our solution includes the following:
- Accepting and reviewing applications for completeness
- Resolving issues surrounding duplicate or incomplete applications
- Determining if an applicant meets eligibility requirements
- Making eligibility determinations in concert with Medicaid staff
- Handling appeals
- Coordinating enrollment processes
- Interfacing with contracted managed care plans and providers
- Answering applicant and other stakeholder questions
- Creating and disseminating program marketing and application materials
CMS recently selected HMS as a Medicaid Integrity audit contractor under the Medicaid Integrity Program.
