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Ohio's Cost Avoidance Efforts & Contractors
The goals of cost avoidance and payment coordination are to minimize Medicaid's financial liability when enrollees have other sources of health insurance.
Ohio's Cost Avoidance Efforts & Contractors

Ohio Medicaid has traditionally emphasized up-front cost avoidance because it is more cost efficient and successful than "pay-and-chase."

Third-party carriers are required to share eligibility information with Medicaid for the purposes of improving cost avoidance.  In State Fiscal Year 2020, Ohio Medicaid avoided $700 million in billed charges up front. Ohio Medicaid recovered $81+ million via pay-and-chase. These amounts represent state and federal shares. The federal share--typically 60 percent--is returned to the federal government.  As for the state share, 40% or $32.4 million was returned through pay-and-chase activities.​

Although cost avoidance provides greater value to the state, ODJFS is also committed to maximizing its pay-and-chase performance. ODJFS currently contracts with HMS to do pay-and-chase.  HMS also performs tort recovery for ODJFS by identifying, managing, and recovering all Medicaid paid funds when a Medicaid recipient is involved in a tort or casualty accident or incident.

Questions?


Contact the Benefit Coordination & Recovery Unit

You may also contact HMS:

HMS, A Gainwell Technologies Company
5475 Rings Rd,  Suite 200,
Dublin, OH  43017

Toll Free: 888-245-9019
Fax: 614-242-1051
Email: ohiotort@hms.com