The ”pay-and-chase” approach to coordination of benefits (COB) claims is a commonly known challenge among health plans. Due to rapid payment requirements and complexity of such claims, plans often miss out on millions of dollars in savings while increasing provider abrasion and expending internal resources to recover overpayments.
A streamlined COB solution with both prospective and retrospective claim review, on the other hand, can help ensure that members' claims are paid in the proper order when covered by more than one plan, resulting in increased cost-effectiveness for plans and reduction of claim payment delays. How significant are the savings from pause-and-pay COB validation?
Read on to explore how a prospective solution may benefit your organization and deliver critical savings while improving member satisfaction.
Prospective and retrospective solutions work in tandem
A reliable and proactive COB solution is essential to prevent overpayments during the claims process. Prepay COB validation can lower medical costs by decreasing overpayments, ultimately improving relationships with payers. By using advanced analytics and a highly skilled team of specialists to review and identify inappropriate claims, Cotiviti’s prepay COB “pauses” the claim before a payment is made.
Retrospective COB validation is used when an order of benefit determination requires a more extensive investigation, or when eligibility is retroactively updated. To ensure high quality, Cotiviti will employ a highly trained specialist to perform all elements of the investigation and outreach.
Watch our two-part video series as I explain Cotiviti’s approach to COB validation—and how it’s unique in the healthcare marketplace.
This comprehensive approach reduces overpayments and improves satisfaction through minimal contact with health plan members. Simultaneously utilizing prospective and retrospective COB validation provides an exhaustive view of each member, allowing access to a rich dataset and valuable expertise.
Case study: How a major health plan improved accuracy and savings with prepay COB Validation
In 2022, a large national health plan added prospective COB review to their payment integrity program. After implementing prepay editing, postpay data mining, DRG review, and retrospective COB validation, the payer added prepay COB to its toolkit. Read our case study and learn how the plan achieved:
- $40 million total COB savings in 2022
- >99% prepay COB program savings capture rate
- 200x increase in prepay COB identifications
Cotiviti has more than 20 years of experience in payment accuracy and partners with five of the largest payers in the nation. As an innovator in the prepay COB market, Cotiviti helps plans improve payment accuracy and member satisfaction while reducing the burden on internal resources. For more information on how our end-to-end suite of payment accuracy solutions can benefit your organization, read our COB Validation fact sheet.
