HMS helps State Employee Benefit Plans control their costs by ensuring appropriate coordination of benefits and identifying and recovering claims paid in error. Using state-of-the-art technology, we access medical (managed care and fee-for-service), dental, pharmacy, and long-term care data to help ensure that the right party pays by:
- Conducting Dependent Eligibility Audits
- Identifying and verifying other commercial insurance policies for employees, retirees, and dependents by leveraging our data use agreements with our network of more than 1000 insurance plans
- Identifying and verifying Medicare eligibility—even for members who are eligible but not enrolled
- Providing subrogation services (if allowed by legislation and the SEBP) by identifying when Workers’ Comp, homeowners, and auto insurance should pay first—and recovering incorrect claims payments
- Ensuring program integrity by performing clinical, financial, and compliance reviews, including
- Credit balance
- Pharmacy audits
- Medical record reviews
- Fraud, waste, and abuse audits
Other Available Services:
Where legislation and/or SEBPs allow, we can also provide:
- Tobacco premium analysis
- Recoveries through the disallowance process
HMS is the only independent vendor with a web-based multi-state HIPP system.
