Medicaid is always payor of last resort. Identifying third party insurance allows the State to cost avoid on claims where a member is enrolled in a commercial insurance plan.
Who is HMS?
Health Management Systems (HMS) is contracted by the State of West Virginia, Department of Health and Human Resources (DHHR), Bureau for Medical Services (BMS) to provide a full range of third party liability (TPL) services.
HMS's TPL program includes cost avoidance, post-payment recovery, casualty and tort recovery, and estate recovery. These services help identify, verify, recover and account for Medicaid expenditures where viable third party resources are available to members.
HMS identifies health insurance coverage in addition to a member’s Medicaid coverage.
HMS assists DHHR with an array of cost effective solutions, including the Health Insurance Premium Payment (HIPP) Program, which shifts the cost of healthcare from the state to liable third parties; and premium collections for the West Virginia Medicaid Work Incentive Program (M-WIN).