In a recent study, CAQH found that inefficient COB processes cost the healthcare industry more than $800 million annually. The bulk of these costs are incurred because health plans often do not have access to high-quality data about other overlapping coverage before claims are paid.
A successful COB program increases efficiency, prevents incorrect payments, and provides a better experience for providers and members, but it requires trustworthy data about coverage overlaps. Many vendors claim to have this data, but the quality varies.
The success of a plan’s COB program hinges on having quality data when making payment decisions. When it comes to selecting a primary source of overlap data, here are six things to look for.
- Where the data comes from. The highest quality data comes directly from other health plans, not from members themselves.
- When you receive it. If the data comes before a claim is paid, you will already know whether you are the primary or secondary payer and can pay the claim correctly the first time, avoiding the extra cost of recovery or re-work.
- The impact on staff. Managing and verifying the data should reduce the administrative burden on team members, not increase it.
- How often it is updated. The more regularly that data is updated, the higher the likelihood that the member information is accurate. Look for at least weekly updates.
- The cost. As COB is primarily done as a cost savings measure, purchasing expensive data can cut into recovered costs. When evaluating potential data sources, look at the cost savings you would expect from better overlap identification, the impact on administrative costs such as phone calls and letters, and the reduction you’d see in vendor expense.
- The availability of out-of-state data. CAQH has found that almost one third of coverage overlap comes from payers in a state other than the one where the member resides, so you need data that covers all 50 states.
Having a source of COB data that you can trust allows you to automate more of your process. By autoloading overlaps into your claims system before claims start rolling in, you’ll prevent costly, manual rework, leaving more time for the many other things on your to-do list.
Run your COB Program More Efficiently
Focusing your COB process on early identification of overlapping coverage to prevent incorrect payments increases efficiency and cost savings. Download our toolkit to get a step-by-step guide to moving your COB process from "pay and chase" to proactive.