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

Rhea-AI Summary

HMS (NASDAQ: HMSY) has launched a new Coordination of Benefits (COB) on Demand solution, enhancing its suite of payment accuracy tools utilized by over 300 health plans and 40 state Medicaid agencies. This solution identifies existing third-party health insurance for Medicaid members, improving billing accuracy and helping reduce the estimated $56 billion in improper Medicaid spending. It can be deployed via API or other interfaces and has already proven effective in states like New Mexico, which identified 92% of third-party liabilities within seven months, leading to estimated annual savings of $2.2 million.

Positive

• Launch of COB on Demand enhances HMS's payment accuracy solutions.
• Identifies third-party health insurance, improving billing efficiency.
• Potential to save over $2.2 million annually for Medicaid agencies like New Mexico.
• Proven effectiveness with a 92% identification rate of third-party liabilities.

Negative

• None.

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.”

Third-party liability (TPL) laws and regulations are designed to ensure that Medicaid is the payer of last resort, which means that for the approximately 7.6 million Medicaid enrollees who have access to coverage from a third-party carrier, that third-party is required to pay all or part of a member’s medical care expenses before Medicaid pays. By identifying third-party coverage at the point of enrollment or during prior authorization, COB on Demand moves typical cost avoidance (CAV) upstream, helping providers avoid pay-and-chase activities and reducing administrative burdens. With 24-hour turn-around time, COB on Demand increases typical CAV performance by up to 15%.

HMS’ COB on Demand solution uses machine learning algorithms, advanced matching logic, application programming interface (API) technology, and rapid batch processing to proactively identify, verify and communicate existing third-party coverage before billing in near real-time from day one of coverage. The proprietary solution is designed for secondary payer and payer of last resort programs including Medicaid, the Children’s Health Insurance Program (CHIP), and the AIDS Drug Assistance Program. COB on Demand can be implemented as an API, Secure File Transfer Protocol (SFTP), or user interface portal and facilitates interoperability with Medicaid Enterprise Systems and other enrollment and claims management systems.

To date, COB on Demand has seven deployments spanning multiple Medicaid agencies, state and federal healthcare exchanges, and Departments of Health providing accurate and rapid healthcare coverage identification for the millions of consumers they serve. 

After deploying COB on Demand, the state of New Mexico received over 75,000 new enrollees in seven months and, during that time, identified 92% of TPL at enrollment. The early identification provided by COB on Demand will save New Mexico more than $2.2M in annual savings.

To learn more about COB on Demand, visit https://www.hms.com/cob-on-demand/ or watch our video.

About HMS
HMS advances healthcare by helping organizations reduce costs and improve health outcomes. Through our industry-leading technology, analytics and engagement solutions, we save billions of dollars annually while helping consumers lead healthier lives. HMS provides a broad range of payment accuracy and population health management solutions that help move the healthcare system forward. Visit us at www.hms.com or follow us on LinkedIn and Twitter.

Media Contact
Lacey Hautzinger
Senior Director, Corporate Marketing
HMS
(469) 284-7240
Lacey.hautzinger@hms.com

FAQ

What is HMSY's new product launched on March 25, 2021?

HMSY launched the Coordination of Benefits on Demand solution to improve payment accuracy for Medicaid members.

How does the COB on Demand solution impact Medicaid spending?

It aims to reduce improper Medicaid spending, estimated at $56 billion in 2019, by identifying third-party health insurance.

What are the key features of HMS's COB on Demand solution?

The solution uses machine learning, API technology, and rapid processing to identify existing third-party coverage in near real-time.

How effective has the COB on Demand solution been in New Mexico?

After deployment, it identified 92% of third-party liabilities during enrollment, potentially saving New Mexico over $2.2 million annually.

How is COB on Demand implemented and what systems does it integrate with?

It can be implemented via API, Secure File Transfer Protocol (SFTP), or user interface portal, facilitating interoperability with Medicaid systems.