Government-Sponsored Health Plans

As state and federal healthcare programs continue to contract with health maintenance organizations and other managed care entities to provide services to covered members, HMS applies our cost containment and recovery services to managed care models. Our services address the cost containment needs of managed care organizations, including Medicaid, Medicare Advantage, and Part D plans.

Medicaid Managed Care

Nearly two-thirds of the Medicaid population is already enrolled in some type of managed care, and as states grapple with increasing access to care through Medicaid expansion and "universal healthcare" options, managed care models are likely to grow.

Since HMOs must abide by the same mandates imposed by federal and state insurance regulations to prevent inappropriate payments where valid other third party liability exists, partnering with HMS can help them to comply.

As of early 2007, more than 20 large Medicaid managed care organizations rely on HMS to locate other valid coverage for 8 million of their Medicaid members. We have products available to assist smaller Medicaid MCOs, as well.

Medicare Advantage and Part D Plans

HMS's services can also benefit Medicare Advantage and Part D plans. HMS's processes identify Medicare Secondary Payors (MSPs), provide verified Group and non-Group Health Plan coverage information, and recover Medicare Advantage payments that are the responsibility of an MSP.

We are also able to provide other specialized services to plans, such as dual eligible identification, premium recovery, and Part D plan/member reconciliation assistance.