Moving Healthcare Forward
HMS advances the healthcare system by helping healthcare organizations reduce costs and improve health outcomes. Through our industry-leading technology, analytics and engagement solutions, we save billions of healthcare dollars annually while helping consumers lead healthier lives. HMS provides a broad range of coordination of benefits, payment integrity and population health management solutions that help move the healthcare system forward.
What We Do
Coordination of Benefits
Individuals can have more than one form of healthcare coverage. For example, some people participate in the Medicaid or Medicare programs and also have employer sponsored coverage. In these cases, HMS ensures the right payer pays healthcare claims for individuals with more than one form of coverage. HMS ensures the accurate identification of other healthcare coverage and gives customers (healthcare payers) detailed policy information required to proactively prevent payment of member claims for which another party is liable.
HMS identifies and corrects improper healthcare billings and payments. We fight fraud, waste and abuse by promoting payment accuracy through claim editing and analytics, clinical claim reviews, utilization reviews, and fraud services.
Population Health Management
HMS identifies risks, increases patient engagement and improves financial and health outcomes. We manage members on a personal level – at enterprise scale – enabling health plans to know and engage their health plan members to better manage member health outcomes.
Based in Irving, Texas, HMS has more than 2,500 employees in 25-plus offices across the country. We are a wholly owned subsidiary of HMS Holdings Corp., traded on NASDAQ (ticker: HMSY), and certified by HITRUST. Permedion, a wholly owned subsidiary of HMS, is a QIO-like entity for Independent Review Organization: External Review and Health Utilization Management.