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HMS Acquires Prudent Rx

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					HMS Innovation: eValidate
HMS is pleased to offer clients the latest enhance-
ment to our cost avoidance service. eValidate is a
Web-enabled point-of-service inquiry application
that provides Medicaid and managed care clients
with immediate access to the most current infor-
mation in HMS’s records about other coverage




                                                                                                                                       Dialogue
for its members.




                                                                                                                                                                                                                                                                FALL 2008
The application allows clients to answer questions
from providers about other coverage. HMS clients can
then request that a policy be reviewed and verified,
and have their records updated with the new informa-
tion with a very quick turnaround. It’s also designed to
help providers know how to correctly bill claims when
there is other coverage.
                                                            Screen capture of the HMS eValidate operating system.                      Contents                   HMS Acquires Prudent Rx
                                                                                                                                                                                            In September HMS      PHS employees. Those employees are still
eValidate is being rolled out to clients where eValidate is the tool of choice for fielding real-time pharmacy inquiries. If           HMS Acquires                                         acquired the busi-    with Prudent and give the company an un-
you’d like more information about how eValidate can be integrated into your provider inquiry process, contact your HMS                 Prudent Rx . . . . . . 1                             ness of Prudent       usually deep pharmacy industry knowledge
account manager.                                                                                                                                                  Rx, Inc., an independent pharmacy audit         foundation.
                                                                                                                                       Comprehensive Program      and prescription management organization
                                                                                                                                       Integrity Solutions for                                                    Auditing pharmacies and pharmacy claims
                                                                                                                                                                  based in California. This acquisition further
                                                                                                                                       Medicaid . . . . . . . 2                                                   is a critical component of any healthcare
                                                                                                                                                                  expands our program integrity capabilities
                                                                                                                                                                                                                  program, and often the only way to iden-
                                                                                                                                       The First Annual HMS       and service offerings for state Medicaid
                                                                                                                                                                                                                  tify potential pharmacy fraud, billing er-
                                                                                                                                       Client Survey . . . . 3    agencies and managed care organizations,
                                                                                                                                                                                                                  rors, and abuse by patients and physicians.
                                                                                                                                                                  particularly in the pharmacy arena.
                                                                                                                                       HMS Runs Away With                                                         Prudent Rx offers expert management and
                                                                                                                                       the Race . . . . . . 3     Prudent Rx’s key products and services          consulting services based on its extensive
                                                                                                                                                                  include audit programs, program design          industry knowledge, experience, and a
                                                                                                                                       HMS TPL Conference
                                                                                                                                                                  and benefit management, as well as gen-         proven track record of helping Medicaid
                                                                                                                                       Update . . . . . . . 3
                                                                                                                                                                  eral and pharmacy systems consulting.           agencies, managed care organizations, and
                                                                                                                                       HMS Wins Key New           The company fields a team of recognized         other pharmacy benefit providers.
                                                                                                                                       Mexico Contract . . . 3    industry leaders with in-depth experience
                                                                                                                                                                  in the prescription benefit management
                                                                                                                                       HMS Innovation:
                                                                                                                                                                  industry. They have a team of desktop
                                                                                                                                       eValidate. . . . . . . 4
                                                                                                                                                                  and field auditors on staff in their Culver
                                                                                                                                                                  City offices.

                                                                                                                                                                  Prior to founding Prudent Rx in 1994, Rus-
                                                                                                                                           Prudent                sell Dates and Laureen Waterman were                Russell Dates        Laureen Waterman
                                                                                                                                         helps round              part of the management team at a phar-          Prudent Rx Co-Founder   Prudent Rx Co-Founder
                                                                                                                                          out HMS’s               macy benefit management (PBM) company
                                                                                                                                                                  called Prescription Health Services (PHS),      Adding Prudent Rx to the team is also an-
                                                                                                                                        position as an                                                            other big step forward in HMS’s strategy to
                                                                                                                                                                  which at the time was the largest privately
                                                                                                                                        independent               held PBM in the U.S.; PHS was subsequent-       bring the entire range of program integrity
                                                                                                                                                                                                                  services to the market through a single
                                                                                                                                          auditor of              ly acquired by Caremark.
                                                                                                                                                                                                                  source. Prudent helps round out HMS’s po-
                                                                                                                                       pharmacies and
                                                                                                        Address Correction Requested
                                                                                                            New York, New York 10016                              Later, when Russell and Laureen founded         sition as an independent auditor of phar-
                                                                                                            401 Park Avenue South
                                                                                                                                            PBMs.                 Prudent, they brought with them a core of       macies and PBMs.
Comprehensive Program Integrity Solutions for Medicaid                                                                                HMS Runs Away With the Race                                                                  receiving the sample file,
                                                                                                                                                                                                                                   with the balance coming
                                                                                                                                      In April 2008, HMS and two other vendors were                                                24 hours later. Accord-
                                 HMS|IntegritySource™           These services can be customized to supplement your
                                                                                                                                                                                                                                   ing to the FSSA findings
                                 is HMS’s one-stop source       organization’s internal efforts. HMS is proud to let you              invited by the Indiana Family and Social Services
                                                                                                                                                                                                                                   report, released on Au-
                                 for a full range of Medic-     know that we were awarded an umbrella Audit Medicaid                  Administration (FSSA) to participate in a Medicaid                                           gust 19th, HMS identified
aid Program Integrity needs, including program analysis,        Integrity Contract for CMS’s Medicaid Integrity Program.
                                                                                                                                      TPL identification and verification assessment.                                              nearly three times more
data mining, clinical review, pharmacy audit, and pre-          In September, HMS was selected as the Audit Medicaid
                                                                                                                                      The FSSA gave each vendor the same listing of 8,000                                          “Total Insurances Identi-
payment solutions.                                              Integrity Contractor for the Dallas region.
                                                                                                                                      randomly sampled Medicaid member records for                                                 fied” than the next ven-
                                                                                                                                                                                                   dor and nearly six times more “Active Insurance.” And,
                                                                                                                                      which it had no other coverage information.
The First Annual HMS Client Survey                                                                                                                                                                 this was accomplished with a 95% accuracy rate.

                                                                                                                                      The challenge was to identify other insurance for the
Several months ago HMS invited clients to complete our first annual “Voice of the Customer” survey.                                   maximum number of members within one week.                   We’re pleased that our continual innovation, TPL-specific
We sought honest feedback on what you see as our strengths,                                                                                                                                        focus, and proprietary data matching algorithms have
as well as where we need to improve. The number of responses                                                                          The HMS team responded immediately, returning the first      been proven to maximize identification and verification of
exceeded our expectations and the feedback was extremely valuable.                                                                    file of validated other insurance less than 12 hours after   other coverage.

Here are some highlights of the survey:
                                                                                                                                                                                                                                          Congratulations to
    The overall response rate was 39%
    Over 90% of respondents were satisfied with HMS overall
                                                                                                                                        TPL Conference Update                                                                              Lisa Gifford, TPL
                                                                                                                                                                                                                                            Director for the
    Over 91% told us they plan to continue doing business with HMS                                                                      This year’s National TPL/COB Conference was held in Denver, Colorado, with the                    Oklahoma Health
                                                                                                                                        theme of “All for One - Uniting Best Practices for a Better COB World.”                             Care Authority,
    More than 90% of respondents expressed high levels of satisfaction with the:
                                                                                                                                        HMS experts participated in panel discussions in five of the seven conference sessions:           for winning HMS’s
                                          Comprehensiveness of HMS solutions
                                                                                                                                                                                                                                          raffle prize: a Wii!
                                          Handling of confidential information
                                                                                                                                                      HIPAA (Post-payment billing and electronic billing)
                                          Approachability, professionalism, and knowledgeof HMS people
   At the same time,                                                                                                                                  Managed Care and TPL
                                          Ethics and integrity of HMS people
      the feedback                                                                                                                                    Subrogation/Casualty and Ahlborn
                                                                                                                                                      TPL and Medical Support Enforcement
  helped us identify
                                                   Operations Processes                                                                               Medicare Program Integrity MIC Audits and Program Information Updates

         key areas                                 We are investing in new process engineering and quality assurance
                                                   capabilities.                                                                                       HMS would like to thank Gary Ashby and his team at the Colorado Department
    in which we are                                                                                                                                      of Health Care Policy and Financing for all their hard work and dedication
                                                                                                                                                                      to making this year’s conference such a success!
       particularly                               Field Processes
                                                  We are currently undertaking a number of organizational, technol-
        focused to
                                                  ogy, and training efforts focused on enhancing the capabilities of
     ensure that we                               HMS field professionals.                                                                                                       HMS Wins Key New Mexico Contract
  continually exceed                               Service Offerings                                                                                                             HMS recently won a competitive procurement to implement a Child
                                                                                                                                                                                 Support Customer Service Unit (CSU) for the New Mexico Human
  your expectations.                               We continue to expand our product offerings in many areas, including
                                                                                                                                                                                 Services Department (HSD). Under this four-year contract, HMS has
                                                   recovery, cost avoidance, and program integrity. Our goal is
                                                                                                                                                                                 established a statewide call center for New Mexico’s IV-D Child Sup-
                                                   to make sure you are aware of the many solutions available to you.
                                                                                                                                                                                 port Program.
While our goal will always be 100% satisfaction, we are still    We are confident that HMS is delivering high value solutions                                                    To support this effort, we have opened an office in Santa Fe, staffed with ap-
pleased that survey results exceeded three independent bench-    with great service, but we will not rest on these laurels. We are                                               proximately 35 specially trained people. Despite an extraordinarily acceler-
mark comparison studies measuring overall satisfaction in        committed to continuing to strive for even better results. To                                                   ated implementation period, HMS successfully implemented our customer
numerous service industry organizations.                         that end, if you have a suggestion or concern, please let us know!                                              service center, including our cutting edge software, within 60 days.

				
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posted:7/23/2011
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