Ohio's Cost Avoidance Efforts & Contractor
The goal of cost avoidance - also called benefits coordination - is to minimize Medicaid’s financial liability when enrollees have other sources of health insurance. Ohio Medicaid has traditionally emphasized up-front cost
avoidance - it is more cost efficient and more successful than trying to "pay and chase."
In July 2007, Ohio passed legislation which requires third parties to share eligibility information with Medicaid for the purposes of improving cost avoidance. In state fiscal year 2008, this legislation helped Ohio Medicaid avoid spending $407 million up front. Ohio Medicaid collected $77 million via third party liability (TPL) recoupments. These amounts represent both state and federal shares. The federal share - typically 60 percent - is returned to the federal government. As for the state share, Ohio Medicaid saved $163 million up front, based on billed charges, and collected $31 million through TPL.
While up-front cost avoidance activities provide a greater opportunity for value to the state, ODJFS is also committed to maximizing its pay and chase performance. ODJFS currently has a competitive bid contract for the post payment review and collection of Medicaid payments when third party coverage exists. ODJFS contracts with HMS to identify, manage, and recover all Medicaid paid funds when a Medicaid recipient was involved in a tort or casualty accident/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