Ohio's Cost Avoidance Efforts & Contractor
The goals of cost avoidance and payment coordination are to minimize Medicaid’s financial liability when enrollees have other sources of health insurance. 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 2010, Ohio Medicaid avoided $705 million in costs up front. Ohio Medicaid recovered $76 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, Ohio Medicaid saved $282 million up front (based on billed charges) and collected $30 million 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:
Ohio Tort Recovery Unit
350 Worthington Rd, Suite G,
Westerville, Ohio 43082
Local: 614-242-1045
Toll Free: 888-245-9019
Fax: 614-242-1051
Email: ohiotort@hms.com