Cost Avoidance

HMS understands the importance of accurate, timely cost avoidance data for healthcare programs. By discovering new coverage information, HMS's clients avoid paying claims for which they are not responsible, resulting in savings worth many times the value of payments recovered retroactively through typical "pay and chase" activities.

By matching eligibility files to HMS's database of national insurance eligibility information, HMS locates other available coverage. We then verify this coverage directly with the carrier through a combination of online tools and telephone outreach. Thus, managed care plans can comply with federal regulations and avoid paying for services for which they are not responsible for covering.

HMS can also periodically re-verify third party liability, locate and verify other segments of coverage (e.g., dental or pharmacy), and determine where other coverage has terminated. These services ensure that the plans remain current with coverage fluctuations and can coordinate benefits accordingly.

As the national leader in cost avoidance, HMS has identified and verified millions of previously undiscovered insurance policies—and helped our clients achieve billions of dollars in savings annually.