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Six Tips to Choose a Medicaid RAC Contractor

Here’s our “Top Six” list of what you should expect from any RAC contractor — and why HMS delivers with a difference:

  1. A full understanding of every aspect of the audit process — right from the start. We conduct face-to-face meetings and conference calls with hospitals, provider associations, and individual providers. We work with multiple contacts at your facility to make sure that everyone has a common understanding of the process and objectives.
  2. A 24/7 state-of-the-art web-based portal to help you navigate the overpayment identification and recovery process — paperless. Through our Provider Portal, claims targeted for potential overpayments are delivered electronically, and can be accessed at your convenience. You can also respond to requests, submit questions, update contact information, and more. Our portal also simplifies the self-disclosure process. Today, more than 26,000 providers use HMS’s Provider Portal to help them manage the audit process.
  3. A full-time Provider Services team to guide you through the audit process. Our team is focused exclusively on responding to your inquiries, and has the experience required to promptly and accurately respond to your questions regarding the review and recovery process. Our Call Center handles thousands of calls every month, and we accommodate time zones across the country. Your medical records and other documents are safe with HMS. When you send them to us, they go directly into our content imaging system, where they are highly secured and ready for prompt processing.
  4. Regular updates on findings. We regularly participate in state hospital and provider association meetings and publish information about trends and issues identified on our website. We also publish quarterly newsletters and conduct webinars to keep you up to date.
  5. A highly skilled Clinical Review team. Our expert review staff includes 770 clinicians and certified coders – all under the direction of our Chief Medical Officer. They work together to review claims and make fair determinations based on your state’s policy and regulations. Our audit expertise crosses all Medicaid service types, including hospital, long-term care, pharmacy, durable medical equipment, and behavioral health.
    Guidance on how to correct overpayment errors in the future. Provider education is important to us. Our determination letters include detailed clinical rationales so you’re 100% clear on why a claim is denied, and how to prevent the overpayment on future claims.

At HMS, our goal is to serve providers with excellence and integrity. Today, providers across the country rely on us as a trusted partner for expertise and guidance.

Contact us for more information on how we can help you with your Medicaid RAC needs.