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