Presentation Showcases How Medicaid Plans Can Improve Coordination of Benefits

With 13 percent of beneficiaries reporting that they have additional coverage, the coordination of benefits process for Medicaid plans can be complicated and costly.

October 2019

CAQH estimates that administrative inefficiencies associated with coordination of benefits cost the industry $800 million each year. At the Medicaid Health Plans of America (MHPA) Annual Conference, Morgan Tackett, Senior Product Manager of COB Smart, and Laura Carraway, Senior Vice President of Cost Optimization-Program Integrity Coordination of Benefits at Anthem, shared recommendations for how to make this process more efficient and accurate.  

The session, “Claims processing and coordination process benefits,” provided an overview of how health plans are currently approaching this process, the associated challenges and how to make it more streamlined. Focused on Medicaid innovation, the 2019 MHPA Annual Conference was attended by more than 400 senior executives and leaders from across the industry.

Currently, coordination of benefits is largely a reactive process wherein health plans do not determine coverage until after a claim has been processed. This “pay and chase” approach can result in incorrect payments, money lost on processing and expensive vendor fees - not to mention unnecessary patient involvement. And, as 13 percent of Medicaid beneficiaries report having additional coverage, these costs can add up.

There are a number of ways that Medicaid plans can make their coordination of benefits process more efficient, including leveraging automation and prioritizing the claims that have the greatest potential for savings. But, having access to high-quality data is critical.

For Medicaid plans in particular, beneficiaries can have multiple breaks in coverage per year, and data can go out of date very quickly. When selecting a data source, it is important to consider how often the data is updated, when it is received and its origins.

To learn more about how COB Smart helps improve coordination of benefits for Medicaid plans, click here.

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