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.
HMS doesn’t use 270/271s for identifying unknown coverage because they aren’t designed for this purpose and don’t yield reliable or complete results. We don’t engage in fishing expeditions with carriers.
