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HMS confidential. Do not distribute. Dependent Eligibility Verification.

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Presentation on theme: "HMS confidential. Do not distribute. Dependent Eligibility Verification."— Presentation transcript:

1 HMS confidential. Do not distribute. Dependent Eligibility Verification

2 HMS confidential. Do not distribute. 1.About HMS 2.Timeline 3.Communications 4.Resources 5.Privacy & Security 6.Questions & Discussion 2

3 HMS confidential. Do not distribute. 3 About HMS  Provides a broad range of cost containment solutions in healthcare to help payers improve performance  Based in Irving, Texas; established in 1974  Proprietary technology platforms built to deliver the services we provide  HITRUST certified  Clients include employers of all sizes across multiple industries: Fortune 500, labor and multi-employer groups, hospitals and health systems, schools, public entities, state and federal government

4 Why Verify With HMS?  Security: A trusted steward of healthcare data, HMS is HITRUST-certified. Our corporate structure includes a Chief Security Officer and a Chief Compliance Officer. These executives ensure every single employee receives training that focuses on the security and privacy of your employee data.HITRUST-certified  Experience: HMS has conducted more than 1,400 dependent eligibility verifications.  Endorsements: HMS is the only provider of Dependent Eligibility Verification services exclusively endorsed by the American Association of School Administrators (AASA) and the American Hospital Association (AHA).  Results: HMS averages a 95% employee response rate and 85% of employees are able to complete verification at their first attempt of submitting documentation to HMS.

5 HMS confidential. Do not distribute. Audit Timeline 5 Grace Period 20 days Grace Period 20 days Service, Support & Resources Audit Results Reported Audit Results Reported Verification 45 days Audit Runout 5 days

6 HMS confidential. Do not distribute. Communications  Mailing #1 – An initial letter that will list the employee’s dependents on the plan, the rules for eligibility and the required documentation to be submitted by the employee.  Mailing #2– Sent 15 days before the initial deadline to employees who have not yet responded.  Final Notice-- A letter will be sent which explains the consequences of a non-response and provides a final opportunity to comply (Grace Period announced).  Confirmation Postcard - If the employee is in full compliance, a confirmation postcard or email will be sent.  Custom Response Letter - For incomplete/incorrect submissions, a customized response letter will be sent. This letter will highlight the areas of non-compliance and request that the employee provide additional information.  Voluntary Term Confirmation - For employees that elect to remove one or more dependents, a voluntary termination confirmation letter is sent to ensure that the intentions of the employee are properly captured. 6

7 HMS confidential. Do not distribute. Document Submissions  Web upload at AuditOS.com  Toll-free digital fax (no paper generated)  U.S. Mail  Documents processed on a first received, first reviewed basis AuditOS is compatible with all smart devices. Employees can use their device to take a picture of their documents and upload directly to their audit file. HMS guarantees documents will be processed within 5 business days; this expectation is typically exceeded. It is not uncommon for documents to be processed the day of receipt. 7 

8 HMS confidential. Do not distribute. 8  Toll-free number specific to your employees  Operates Monday-Friday, 8am – 8 pm ET  Spanish speaking representatives are always available  More than 150 languages are supported via a Language Line to include live translators  Representatives can reference resources for employees who need to order documents  IVR features during operating & non-operating hours  Representatives do not end a call without informing the employee of their overall status and any documents that remain outstanding Call Center

9 HMS confidential. Do not distribute. 9 Employee Web Portal  Access to information 24/7  Green Opt-In  Look up status  Review FAQs  Review eligibility rules  Determine where to find documents  Ability to ask questions  Document upload  Copies of communications  Coverage options

10 HMS confidential. Do not distribute. Privacy & Security  HMS is HITRUST Certified (HIPPA Compliance)  Privacy policy & security measures are described in communications sent to employees and at every page at AuditOS  Representatives can also answer inquiries regarding integrity of data & documents.  Personal Identifying Information is treated as Personal Health Information  No Need for SSN—never referenced  HMS has never had a breach of security/personal data  HMS is required to self-report if there is a data/security breach  Employees are instructed what detail is necessary and which can be redacted from documents submitted to HMS 10

11 HMS confidential. Do not distribute. As a result of our comprehensive communication strategy and proprietary technology platform:  HMS averages a 95% employee response rate  85% of employees complete the audit process at their first attempt of submitting documents to HMS 11

12 HMS confidential. Do not distribute. Perpetual Solution  Automated, repeated process  Dependents verified within the first 30-45 days of enrollment—during onboarding or at the time of a QE  Minimizes exposure to ever paying a claim for a dependent who was never eligible. 12

13 HMS confidential. Do not distribute. 13

14 Enterprising healthcare HMS confidential. Do not distribute.


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