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
for its members.
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
industry. They have a team of desktop
eValidate. . . . . . . 4
and field auditors on staff in their Culver
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-
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:
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-
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.
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.