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Medicaid Coordination of Benefits

Your Strongest Partner to Maintain the Strongest Plan.

Coordination of Benefits

One of the best ways to keep your Medicaid Managed Care Organization (MCO) strong is to ensure that you only pay claims for members who do not have other health insurance.

This Coordination of Benefits (COB) is complex because coverage changes frequently, and payers should check third party liability at multiple points: during enrollment, re-enrollment, point of service, claim adjudication, and post-payment.

Enter HMS. Nobody has deeper experience, better matching technology, or access to more member and insurer data.

HMS pioneered COB for Medicaid MCOs in 1985 – and it’s been our core competency ever since. Unlike some trying to enter the market with repurposed solutions originally created for providers, our IT infrastructure and data mining algorithms were custom-built for Medicaid COB and payers. They include a balanced approach to cost avoidance and recovery.

As the preeminent COB contractor, our data is the best in the industry, and our usage agreements are already in place. We continually receive refreshed coverage information from more than 1,000 plans, including major medical, dental, prescription drug, and vision payers. The information is consistently verified for accuracy.

Continuously improving our best-in-class solution ensures maximum recoveries and cost avoidance for you. This is more than just state-of-the-art hardware and software – the technology at HMS is supported by 1,500 Medicaid professionals who designed, built, and continue to enhance and operate the systems.

Beyond COB identification, we can pursue recovery for any healthcare claim that was paid inappropriately. We submit Medicaid COB claims directly to insurers, third party administrators, pharmacy benefit managers, large employers, and other claims processing entities.

With seasoned experience, we identify other insurance as close to enrollment as possible to ensure accurate capitation payments. An integral part of this process includes working with encounter claims data, and coordinating come-behind billing. As managed care populations grow, your plan can continue to not only operate smoothly, but thrive.

Contact us today and let our strengths make your plan stronger.