Case Management
HMS has a variety of case management services for revenue recovery and cost containment. Our services can be applied retroactively to recover payments (such as those tied to casualty or estate cases) or to save costs (such as HIPP).
Recovery
Casualty services identify and recover Medicaid expenditures for members injured through the willful or negligent action of another party. HMS provides rapid case identification through referrals and data matches, effective communication with stakeholders (including providers, attorneys, insurers), and efficient case management.Estate services identify and recover Medicaid expenditures from the estates of deceased Medicaid members. HMS addresses the many complex issues that affect estate recovery initiatives, including: (i) the necessity for political and legislative support, (ii) the need to integrate disparate data sources, including probate and property ownership and tax data, (iii) the labor-intensive effort required to develop cases and file and pursue claims, and (iv) the complexity of state probate laws.
HMS uses a proprietary Subrogation Recovery System to manage casualty and estate recovery cases. This fully integrated system facilitates all aspects of case management, including creating correspondence, tracking case activity, importing and exporting case data, and prioritizing cases.
Cost Savings
State Medicaid agencies rely on Health Insurance Premium Payment (HIPP) programs to pay the insurance premiums for group health insurance that is available to their beneficiaries when that insurance is cost effective. HMS's approach streamlines the discovery of employer-sponsored insurance via referrals and beneficiary communications, determination of cost-effectiveness, enrollment and premium payment administration, and periodic redetermination.Medicare Buy-In programs pay qualifying Medicaid beneficiaries' Medicare premiums when cost-sharing results in overall savings to Medicaid. By identifying and managing dual eligible enrollments, HMS helps Medicaid programs rely on Medicare to cover the costs associated with certain services for these members.