HMS offers a full suite of services to appropriately manage the premium billing and collection of premiums for state programs. Following generally accepted accounting principles and adhering to strict internal financial controls, HMS uses an established process for requesting, receiving, depositing, and reporting on collected funds.
Our solution includes mailing vouchers to billing program participants, distributing notices to participants regarding payment-related issues, managing incoming payments through a lockbox, handling payment reconciliation issues, and reporting on funds collected.
Also critical to the success of HMS’s premium payment offering is our full service customer service component which provides program participants a means to communicate with knowledgeable representatives who can answer inquiries and quickly resolve issues.
With an integrated approach, we facilitate program access, perform thorough outreach to members, and allow all forms of payment, thus reducing member churn and unnecessary program expense.
Medicaid-Specific Programs
Medicaid agencies rely on Health Insurance Premium Payment (HIPP) programs to pay the insurance premiums for group health insurance that is available to their beneficiaries when that insurance is cost effective. HMS's approach streamlines the discovery of employer-sponsored insurance via referrals and beneficiary communications, determination of cost-effectiveness, enrollment and premium payment administration, and periodic redetermination.
Medicare Buy-In programs pay qualifying Medicaid beneficiaries' Medicare premiums when cost-sharing results in overall savings to Medicaid. By identifying and managing dual eligible enrollments, HMS helps Medicaid programs rely on Medicare to cover the costs associated with certain services for these members.
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.
