HMS Launches Coordination of Benefits on Demand Solution with Near Real-Time Insight into Other Coverage
March 25 2021 - 8:00AM
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 HMSHMS 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 ContactLacey HautzingerSenior Director,
Corporate MarketingHMS(469) 284-7240Lacey.hautzinger@hms.com
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