About

Moving Healthcare Forward

HMS is a leading healthcare technology company, helping healthcare organizations reduce costs and improve health outcomes. Our innovative technology, analytics and engagement solutions save billions of dollars annually while helping health plan members lead healthier lives. HMS provides a broad range of coordination of benefits, payment integrity, care management and member engagement solutions that help move the healthcare system forward.

 

 

What We Do

Coordination of Benefits
Individuals can have more than one form of healthcare coverage. For example, some people participate in the Medicaid or Medicare programs and also have employer sponsored coverage. In these cases, HMS ensures the right payer pays healthcare claims for individuals with more than one form of coverage. HMS ensures the accurate identification of other healthcare coverage and gives customers (healthcare payers) detailed policy information required to proactively prevent payment of member claims for which another party is liable.

Payment Integrity
HMS identifies and corrects improper healthcare billings and payments. We fight fraud, waste and abuse by promoting payment accuracy through claim editing and analytics, clinical claim reviews, utilization reviews, and fraud services.

Total Population Management
HMS identifies risks, increases patient engagement and improves financial and health outcomes. We manage members on a personal level – at enterprise scale – enabling health plans to know and engage their health plan members to better manage member health outcomes.

Company Details

Based in Irving, Texas, HMS has more than 2,500 employees in 25-plus offices across the country. We are a wholly owned subsidiary of HMS Holdings Corp., traded on NASDAQ (ticker: HMSY), and certified by HITRUST. Permedion, a wholly owned subsidiary of HMS, is a QIO-like entity, and is URAC-accredited for Independent Review Organization: External Review and Health Utilization Management.

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