Profile: HMS Holdings Corp (HMSY.O)
17 May 2019
HMS Holdings Corp., incorporated on October 4, 2002, is a holding company. The Company, through its subsidiaries, operates in the United States healthcare insurance benefit cost containment marketplace. The Company provides coordination of benefits services to government, and private healthcare payers and sponsors. Its payment integrity services ensure that healthcare claims billed are accurate and appropriate.
The Company offers services to state Medicaid agencies, government health agencies and health plans, including Medicaid managed care, Medicare Advantage and group and individual health lines of business; government and private employers, and other healthcare payers and sponsors, including child support agencies. The Company serves approximately 45 state Medicaid programs and the District of Columbia, and government health agencies, including Centers for Medicare and Medicaid Services (CMS) and the Veterans Health Administration (VHA). It also provides services to approximately 250 health plans and supports their multiple lines of business. It additionally serves as a subcontractor for certain business outsourcing and technology firms.
The Company's coordination of benefits offering to customers consists of services that draw principally upon information management and data mining techniques. The Company's services are applicable to the federal, state and commercial health plans, and address errors across the payment continuum, from an individual's enrollment in a program before any medical service is rendered, to pre-payment review of a claim by a payer, through recovery audit where discovery of an improper payment is made. The Company's services also address the spectrum of payment errors, from eligibility and coordination of benefits errors, to the identification and investigation of potential fraud, and extend to various claim types. The Company's range of services includes coordination of benefits services, payment integrity services and eligibility verification services. The Company provides cost avoidance services, in which it provides insurance coverage information that is used by government-sponsored payers to coordinate benefits for incoming claims. For Medicaid agencies, the Company also provides estate recovery services to identify and recover Medicaid expenditures from the estates of deceased Medicaid members in accordance with state policies.
The Company provides services to assist customers in identifying other third-party insurance and recovering medical expenses where a member is involved in a casualty or tort incident. For Medicaid agencies, it provides estate recovery services to identify and recover Medicaid expenditures from the estates of deceased Medicaid members in accordance with state policies. The Company's payment integrity services are designed to verify that medical services are utilized, billed and paid. The Company's payment integrity services combine data analytics, clinical expertise and technology to identify improper payments on both a pre-payment and post-payment basis; identify and recover overpayments or underpayments; detect and prevent fraud, waste and abuse, and identify process improvements. The Company's eligibility verification services include asset and income verification, premium assistance, dependent eligibility audits and other verification solutions. The Company provides its products and services under contracts or sub-contracts that contain various fee structures, including contingency fee and fixed fee arrangements.
The Company competes with Optum, Inc., Public Consulting Group, Inc., Emdeon Inc., HP, Xerox, CGI Federal, Inc., Cotiviti, Performant Financial Corp., Cognosante, Myers & Stauffer LC, Verisk Health, Inc. and LexisNexis Risk Solutions.
HMS Holdings Corp
5615 High Point Dr
IRVING TX 75038-2453