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Third Party Liability

Proven Experience. Proven Savings.

Third-Party-Liability

With today’s tight budgets, it’s more important than ever that your agency only pays healthcare claims when no other coverage is available to the member. Finding that third party liability (TPL) is what we do best. Nobody has deeper experience, better matching technology, or access to more member and insurer data than HMS.

Effectively coordinating benefits can be difficult. We know. We pioneered TPL for Medicaid more than 30 years ago and we’ve been helping agencies find recoveries and avoid costs ever since.

This TPL solution is tried, tested, and proven. It includes a balanced approach to cost avoidance and recovery. HMS® innovations have evolved continuously over more than three decades of providing best-in-class identification and recovery solutions to more than 40 state Medicaid agencies, AIDS drug assistance programs, the U.S. Department of Veterans Affairs, and the U.S. Department of Defense.

HMS has a secure IT infrastructure purpose-built from the ground up for Medicaid agencies. Unlike others attempting to repurpose systems originally built to service providers, we have continuously updated eligibility data from more than 1,000 insurers — and, importantly, our data-sharing relationships are already in place.

We verify coverage directly with insurers, including major medical, dental, prescription drug, and vision payers, and deliver the information to states in order to minimize future overpayments. Our unique perspective allows us to identify and integrate best practices from Medicaid TPL programs across the country.

This is more than just state-of-the-art hardware and software — the technology at HMS is supported by 1,500 Medicaid TPL professionals who designed, built, and continue to enhance and operate the systems.

With seasoned TPL experience in managed care and fee-for-service environments, 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 agencies can continue to not only operate smoothly, but thrive when using TPL.

Contact us today and discover what we can do for your bottom line.