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Coordination of Benefits

Comprehensive COB solutions that seamlessly integrate to deliver unmatched financial results.

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Maximize return on investment through cost savings and recoveries.

HMS pioneered coordination of benefits (COB), also known as third-party liability (TPL), nearly 40 years ago. Today, as part of Gainwell, HMS COB solutions for commercial, Medicaid, Medicare, military, and state agency programs continue to deliver value and drive innovation.

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$10 Billion

Total Recoveries & Savings

21+ Million

Cost Avoidance Records Delivered

4.8 Billion

Claims Processed

Pre-Payment Solutions

The goal is always to maximize cost avoidance for your plan. Our proven market expertise pairs with our end-to-end COB solutions to amplify speed to delivery and provide truly actionable insights.

Post-Payment Recovery

Our Post-Payment solutions leverage AI and machine learning to examine improperly paid claims. Then, we pursue those recoveries using proven, efficient digital processes to maximize savings.

Case Management

Our Case Management solution drives cases to reimbursement and closure by making sense of disparate data. We deliver secure and reliable digital access and real-time updates, document imaging, and a guided workflow with support from our expert case managers and attorneys.

Additional solutions making healthcare more efficient and effective.

Payment Integrity

Helping plans avoid and recover improper payments while detecting and preventing fraud.

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Care Quality

Enabling quality care and affordability with strategies that balance empathy and efficiency.

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Data & Analytics

Transforming your most complex data into actionable insights with Gainwell Genius™.

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Verification Solutions

HMS Verification Solutions ensure states verify eligibility, residency, and engagement requirements quickly, accurately, and transparently—protecting coverage for members and their dependents who qualify and stopping waste before it starts.

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Actionable insights that
empower healthcare progress.

We deliver ideas that help shape the future of healthcare.

AI-Enabled Clinical Claim Reviews: Improving Accuracy, Speed, and Trust 

AI-Enabled Clinical Claim Reviews: Improving Accuracy, Speed, and Trust 

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How can we support you?

Speed outcomes with integrated coordination of benefits solutions that have delivered $10 billion in cost recoveries and savings.

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Federal mandates are accelerating. Interoperability deadlines are here. AI is no longer optional — it's an operational imperative. This 3-minute diagnostic reveals where your Medicaid program stands across the five dimensions that matter most.

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