Coordination of Benefits

Coordination of Benefits

Discovering other insurance and determining your payment liability is complicated and constantly changing. We make it easier for your team. Our end-to-end COB services deliver savings at every point along the COB continuum. Maximize your savings with a comprehensive solution or augment your internal processes with any one of our COB services.

Why this solution?

COB Optimization

Engaged at every step in the COB process, we deliver customized solutions that produce tangible savings.

Resource Management

We can catch errors rules-based systems can’t.Let us take on the resource-intensive COB process or easily integrate with your workflow and free up your team to focus on other priorities.

Improved Claims Accuracy

We take the time to verify the data and immediately share it with you to improve quality, compliance and prevent future mispayments.

Savings and COB Cost Avoidance

Experience industry-leading savings and cost avoidance.

Proactive Outreach

We efficiently contact other carriers, employers and members to identify and verify coverage information as a part of our COB process and through our Survey Services. We customize data-driven, automated solutions to achieve your COB program objectives. Our focused approach mitigates unnecessary member touchpoints while maximizing savings opportunities.

 

Data Verification

Our data verification review uncovers incorrect records from internal sources as well as external sources such as CMS and Data Sharing feeds. We reach out to other insurance payers (i.e., commercial, Medicare, MedAdvantage , Medicaid) to verify the items you require for accurate claims payment and coordination according to NAIC, CMS guidelines and your own standard operating procedures.

 

Primacy Determination

Uncovering other insurance coverage is the tip of the iceberg. Utilizing analytical skills and claims expertise, we take the additional steps necessary to determine primacy so that you have accurate, actionable data to update your system and improve claims quality. We help you coordinate correct claim payment when a member has additional primary insurance or third-party liability coverage.

 

Overpayment Identification

Once we have confirmed other coverage is primary, we PreVent future claim overpayments and retrospectively review paid medical claims history in order to minimize leakage. We will also data-mine for overpayments related to COB that occurred prior to your awareness of other insurance.

 

Overpayment Recovery

If overpayments cannot be withheld from future payments, we can seamlessly pursue the recovery through our overpayment recovery service. Utilizing decades of experience and our custom-built recovery system, we will take a customized approach to your COB claims to maximize recoveries while preserving your brand reputation.

COB Review, Resolution and Recovery

If you use a national or state COB registry to identify instances of overlapping coverage and primacy, you are still missing opportunities for savings. Using a series of validation and primacy determination services, we ensure significant savings for health plans and your clients.

Step 1. Quality Review of Data

While sharing the data is a step in the right direction, participating payers have identified potential data integrity issues. Manual reviews are encouraged to validate data quality and that’s where we can help.

Our experience reveals approximately 80% of the data is correct. Let us uncover the other 20% through a review of select codes such as “primacy undetermined” records, targeted other payers , or even the entire file.

Step 2. Resolve the Weekly Undetermined Records

Up to 50% of your weekly file may be “undetermined” for reasons such as two-plan maximum exceeded, initial coverage date undefined, no rules in place to process “other” plan types, coverage expired or overlap and more.

Let us do the legwork for you to determine primacy by calling the other carrier, employer and/or member, or by conducting survey outreach to eliminate overpayment gaps.

Step 3. Identify and Recover COB Overpayments

With the increased discovery of other insurance, we also help payers identify and recover COB overpayments more quickly.