HMS offers full program administrative services for premium assistance programs. Following state guidelines we determine health insurance premium payment eligibility, automatically calculate cost-effectiveness for the program, review proof of health insurance premium payment documentation, and transmit payment.
HMS uses our Premium Identification and Evaluation for Reimbursement (PIER) system to track potential applicants all the way through to payments made to qualifying families and individuals. PIER also provides a completely integrated system for letter generation, case tracking, payment history, images of proof of payment, and reporting all program statistiics. Finally, we transmit eligibility and payment information directly to a state’s system, so a member’s standing is always known.
Key to administering a successful premium assistance program is our deep industry knowledge across multiple states and programs. We leverage this information to bring your program a solution that considers best practices across the country, and staff who are fully trained and knowledgeable of program policies. Our experience means we can offer the highest level of customer service to program participants and maximum savings to states’ bottom lines.
HMS also 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.
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.
