HMS Launches Coordination of Benefits on Demand Solution with Near Real-Time Insight into Other Coverage

Solution is part of HMS’ suite of innovative payment accuracy solutions used by more than 300 health plans and 40 state Medicaid agencies

IRVING, Texas, March 25, 2021 (GLOBE NEWSWIRE) -- HMS (NASDAQ: HMSY), a leading provider of payment accuracy and population health management solutions, has launched a Coordination of Benefits (COB) on Demand solution as part of its suite of industry-leading COB solutions. As healthcare continues to evolve, real-time eligibility solutions offer measurable value to COB programs. COB on Demand offers near real-time insight – starting day one of coverage – into whether Medicaid members have other existing third-party health insurance, ensuring the correct payer is billed for patient care.

According to HMS’ data, approximately 20% of Medicaid members have access to other healthcare coverage, but it is often difficult for health plans and providers to identify when this is the case, contributing to the $56 billion of improper Medicaid spending in 2019 alone. With COB on Demand, state Medicaid agencies and health plans can quickly identify all relevant coverage at the point of enrollment or prior authorization, helping to preserve the integrity of Medicaid as a payer of last resort and significantly reducing costs and administrative burdens for both payers and providers.

Amid the current health crisis and with Medicaid enrollment on the rise, ensuring the fiscal integrity of public health and safety-net programs is especially critical as state Medicaid agencies grapple with budget deficits brought about by the pandemic. Additionally, agencies can leverage COB on Demand to validate high-cost claims, as well as claims related to COVID testing and vaccinations.

“The coordination of patient benefits is critically important to the success of the American healthcare system, especially as safety-net programs like Medicaid are experiencing enrollment surges due to the COVID-19 pandemic,” said Michele Carpenter, SVP Government Services for HMS. “Identifying which patients have coverage through multiple health plans is a huge administrative burden for payers and providers alike and can cause patients to be billed incorrectly. With COB on Demand, Medicaid agencies and health plans can rapidly identify when a patient has coverage through a third-party plan other than Medicaid, reducing administrative hurdles and ensuring providers are reimbursed correctly.”