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), a Gainwell Technologies Company, 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.
The TPL program from HMS, a Gainwell Technologies Company, 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, a Gainwell Technologies Company, identifies health insurance coverage in addition to a member's Medicaid coverage.
HMS, a Gainwell Technologies Company, 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).