Services for the Military
HMS provides customized third party liability and coordination of benefits solutions to the Department of Veterans Affairs (VA), Veterans Health Administration (VHA) and to the Department of Defense (DOD) including both Military Treatment Facilities (MTF) and the TRICARE Management Activity (TMA). Our work with these military services entities helps them meet revenue goals and service obligations to both veteran and active duty populations.
We currently provide insurance identification and verification services to all 21 Veterans Integrated Service Networks (VISN) including over 140 of all VHA Medical Centers (VAMC). Our work on behalf of the VA has yielded significant results allowing for Medical Centers to collect over $200 million in third party payments from commercial health insurance carriers. As a result of the successful contracts, the VHA Chief Business Office (CBO) awarded HMS with a Blanket Purchase Agreement (BPA) in 2006 through a competitive procurement process. In 2008, we were awarded six new regional BPAs by the VHA CBO covering a variety of services including insurance identification & verification, re-verification, and accounts receivable follow up services. These BPAs offer our proven solutions to the VHA at discounted rates. Our “stamp of approval” as a qualified VHA vendor means that VHA facilities can obtain HMS’s services without needing to issue an RFP.
HMS’s specialized services for the VHA include the following:
Insurance Identification and Verification. Our VHA-tailored service approach has resulted in HMS loading hundreds of thousands of previously unknown commercial insurance policies to the VistA system. HMS’s vast carrier network and unique data analytics process enable us to locate previously unknown third party coverage for veterans. With a proprietary data match process and a dedicated verification unit, HMS maximizes the amount of verified insurance policies identified and loaded to our VHA client’s systems. Our clients are currently realizing an average Return-On-Investment of $25:$1 for this service.
Insurance Re-Verification. This HMS process was designed to assist our clients meet their mandated requirements by re-verifying the health insurance on file for active patients semi-annually. The re-verification process ensures that the commercial insurance data on file is correct and current. By applying specialized data matching and verification techniques, HMS can re-verify thousands of policies quickly and accurately. As a result, recovery dollars increase, costs associated with erroneous billings are reduced, and policy continuations and terminations are located.
Buffer File Management. With new policies reaching the Insurance Buffer file daily, and limited staff resources available to process them for billing, keeping the file up-to-date can be a time-consuming, administrative burden. HMS’s Buffer File Management service enables quick turnaround of records from the Insurance Buffer File to VistA. For facilities with a backlog of insurance records on the Insurance Buffer File, we can verify these records and clean out the file to ensure that potential recovery opportunities are maximized.
Accounts Receivable Follow Up. With the awarding of two contracts for A/R Follow Up from the VHA, HMS is now able to offer our VHA clients a service we have successfully provided to other state and federal clients over the years. This service involves conducting analysis and follow up on outstanding third party insurance claims the Medical Centers have on file to maximize recoveries. Our proprietary systems allow HMS to focus on following up on all of the claims, not simply the high dollar claims.
Tort Identification and Recovery. This is one of HMS’s core lines of business that can show valuable returns for our VHA clients. By assisting the Regional Council (RC) identify and maximize the recoveries on Tort Feasor cases, HMS helps reduce costs and increase recoveries. Our data mining processes and unique database systems help ensure that Tort Feasor cases are appropriately pursued and funds are recovered from the liable parties.
Check-in Direct – NEW! This patient registration and check-in kiosk system interacts directly with our proprietary insurance identification and verification process to find insurance for patients faster. This system helps our clients reduce costs, improve billings, and generate additional recoveries.
HMS’s specialized services for the DOD include the following:
Other Health Insurance Discovery and Verification. Our MHS-tailored service approach has been used successfully by TMA in pilot programs and is now in the start-up phase with Moncrief Army Community Hospital at Fort Jackson, SC. HMS’s vast carrier network and unique data analytics process enable us to locate previously unknown Other Health Insurance (OHI) coverage for veterans. With a proprietary data match process and a dedicated verification unit, HMS maximizes the amount of verified OHI policies discovered and returned to our clients.
Other Health Insurance Re-Verification. This HMS process was designed to assist our clients keep their OHI databases accurate and up-to-date. The re-verification process helps to ensure that Military Treatment Facilities (MTF) can bill confidently and accurately. By applying specialized data matching and verification techniques, HMS can re-verify thousands of policies quickly and accurately. As a result, recovery dollars increase, costs associated with erroneous billings are reduced, and policy continuations and terminations are located.
To streamline federal contracting opportunities, HMS's recovery audit services are available to federal purchasers through the GSA Schedule. Click on the GSA logo below for more details.
Our National Eligibility Database includes eligibility data from well over 1,000 plans, including TPAs and PBMs.
