HMS, Medicaid Recovery Audit Contractor, Licenses Milliman Care Guidelines®

SEATTLE, Nov. 29, 2011 /PRNewswire/ -- HMS, one of the nation's leading Medicaid Recovery Audit Contractors (RAC), has signed a five-year license agreement with Milliman Care Guidelines to use the Milliman Care Guidelines® content and software in RAC reviews of Medicaid claims.

Under federal law, Medicaid RACs review claims for compliance with CMS and State reimbursement policies, and identify both underpayments and overpayments.  HMS will use the Care Guidelines® for Medicaid RAC reviews in Connecticut, Delaware, Maine, Nevada, New Jersey, New Mexico, New York, Oregon, South Carolina, Tennessee and Utah.  

To review proper clinical services, HMS will use seven of the annually updated, evidence-based Care Guidelines® products -- Ambulatory Care, Inpatient and Surgical Care, General Recovery Guidelines, Recovery Facility Care, Home Care, Chronic Care Guidelines and Behavioral Health Guidelines, all within interactive CareWebQI® software.  CMS does not mandate or endorse any specific guidelines or criteria for medical reviews.

"This breadth and detail of the Care Guidelines® enable informed and consistent clinical decisions for the best possible care throughout the entire care continuum," said Kevin Daly, Milliman Care Guidelines Principal and Vice President of Sales.  "Having access to our evidence-based clinical tools enables quality and audit organizations to effectively manage their review processes and initiatives to improve the care provided for Medicaid beneficiaries."

The Care Guidelines® promote healthcare quality by providing clinical guidelines based on the best available clinical evidence.  The Care Guidelines® also incorporate detailed quality measures from national standards-setting groups such as the Hospital Quality Alliance (CMS Core Measures).  Each guideline topic outlines key issues, and provides details on clinical interventions to improve patient outcomes.

About HMS (NASDAQ:HMSY)

HMS is a national leader in coordination of benefits and program integrity services for healthcare payors. HMS's clients include health and human services programs in more than 40 states; commercial programs, including commercial plans, employers, and more than 130 Medicaid managed care plans; the Centers for Medicare and Medicaid Services (CMS); and Veterans Administration facilities. As a result of the company's services, clients recovered more than $1.8 billion in 2010, and saved billions of dollars more through prevention of erroneous payments.

About Milliman Care Guidelines

Milliman Care Guidelines LLC, A Milliman Company, is located in Seattle, and independently develops and produces evidence-based clinical guidelines and a variety of software options that are used by more than 1,900 clients nationally to support the care of a majority of US health plan members.  Covering the continuum of care, the seven-product Care Guidelines® series is updated annually by an experienced team of clinicians.  For more information, visit www.careguidelines.com.

About Milliman

Milliman Care Guidelines is a wholly owned subsidiary of Milliman, Inc.  Milliman is among the world's largest independent actuarial and consulting firms.  Founded in Seattle in 1947 as Milliman & Robertson, the company currently has 53 offices in key locations worldwide.  Milliman employs more than 2,500 people.  The firm has consulting practices in healthcare, employee benefits, property & casualty insurance, life insurance and financial services.  Milliman serves the full spectrum of business, financial, government, union, education and nonprofit organizations.  For further information, visit www.milliman.com.

SOURCE Milliman Care Guidelines