Accent's COB Discovery service eliminates the resource intensive process of other coverage identification from payers, allowing them to focus on correct and timely claim payment.

Coordination of Benefits (COB) occurs when an insured is covered by more than one health plan or has multiple sources able to reimburse for health care expenses. When the insured has more than one source of reimbursement, the sources must coordinate their benefits to pay no more than 100% of total incurred costs.

Specifically, when coordinating benefits, a sequence is established where the primary plan pays first and the second form of coverage pays the difference between what is paid by the primary plan and the total allowed charges.

Industry Challenges

Many payers attempt to detect multiple coverages. In some cases, payers have dedicated departments to COB data gathering; in other cases, payers simply do not have the resources available to perform investigation. Even in instances where a payer has dedicated resources, the payer's processes are typically cumbersome and are not a core competency. Additionally, there is not always a guarantee that data gathered during the investigation process will be properly input into the system to ensure that future claims will be paid correctly.

Facing the Challenges: Accent's Solution
Accent has developed a COB DiscoverySM service that relieves payers of the administrative burden and expense of other coverage identification. With COB DiscoverySM, Accent collects, manages, and reports other insurance coverage information on the membership population so payers can prevent improperly paid claims. Accent's focus minimizes member contact while still conducting the necessary investigation to find other coverage.

Accent's COB DiscoverySM service will satisfy the core requirement that payers identify other coverage within their insured population. When other coverage is identified by Accent, transmitted to the payer and uploaded into the payer's system, claims can then be processed correctly according to the primacy sequence. This eliminates incorrect payments and administrative expenditures associated with identifying and correcting the claim payment. Additionally, Accent can investigate all past claims in the insured's file to determine if overpayments exist.

Automating the COB DiscoverySM workflow minimizes both labor and operational expenses while ensuring the payer is in compliance with their customers' and the Medicare program's policies and procedures. Consequently, payers are more likely to increase customer retention and avoid costly federal fines.

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