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Verification Solutions

Integrity Verified. Confidence Delivered.

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Smarter verification that protects coverage and reduces waste.

State Medicaid and private agencies must verify eligibility, residency, and engagement requirements faster and more accurately, without rebuilding systems. HMS Verification Solutions brings together four proven verification products—Community Engagement, Residency, Dependent, and Pension Beneficiary—on one platform to help you prevent improper payments, protect coverage, and meet federal mandates like H.R. 1. With rapid deployment, real-time data matching, AI-driven automation, and audit-ready reporting, you’ll streamline operations, reduce waste, and gain full visibility into verification outcomes.

Contact us to start the conversation today.

25+

years’ experience, 43 states served, and 3,500+ projects nationwide

60-90

days implementation

2,000+

CEV medical frailty codes, built by in-house clinicians across medical, behavioral, and pharmacy claims

Solutions designed to improve experiences and streamline operations.

Community Engagement Verification

Meet H.R. 1 mandates in 90 days or less with AI-enabled automation and member-first design. Gain visibility into participation, exemptions, and outreach so you can simplify compliance without disrupting coverage. Ask how to protect your state’s most vulnerable members with our medical frailty logic.

Residency Verification

Identify out-of-state members and duplicate enrollments in real time to protect every healthcare dollar. Automated disenrollment and capitation recovery turn verification into prevention.

Dependent Verification

Verify dependents with speed and sensitivity. Our digital self-service portal and omnichannel communication achieve a 95 percent response rate and help keep eligible families covered.

Pension Beneficiary Verification

Protect pension assets and ensure payments go to the right beneficiaries. HITRUST-certified automation uses trusted national records to confirm eligibility and reduce fraud.

Additional solutions making healthcare more efficient and effective.

Payment Integrity

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

Care Quality

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

Coordination of Benefits

Providing comprehensive and innovative third-party liability solutions.

Data & Analytics

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

Actionable insights that
empower healthcare progress.

We’re passionate about delivering ideas that can help shape the future of healthcare, using education and transparency to improve health outcomes for all.

CEA blog

Community Engagement Verification Made Simple

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Gainwell Announces Enhanced Community Engagement Verification Platform with AI Precision Matching and New Innovation Ecosystem

Gainwell Announces Enhanced Community Engagement Verification Platform with AI Precision Matching and New Innovation Ecosystem

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Gainwell Launches Community Engagement / Work Requirements Verification Solution

Gainwell Launches Community Engagement / Work Requirements Verification Solution

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HMS Community Engagement Verification

HMS Community Engagement Verification

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How can we support you?

Explore how Gainwell simplifies eligibility, residency, and engagement verification without system rework.

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Is Your State Ready for What CMS Expects Next With AI?

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.

15 questions · 5 categories · Takes ~3 minutes