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Three Considerations for Building a Proactive COB Program

When you think about coordinating benefits, you likely think of a costly and time-consuming process with minimal ROI. That’s because many plans take a reactive approach to coordination of benefits (COB) and pay claims before identifying overlapping coverage. This results in the need to recover improper payments which is often performed manually, frustrating to both members and providers, and negatively impacts the entire payment integrity (PI) process.


With more data available than ever before, it’s no longer necessary to rely solely on manual processes and recovery efforts. Access to prospective and real-time COB data can drive accuracy upstream in the PI process, and enable greater payment accuracy, provide a better member and provider experience, and streamline health plan operations.


Here are three ways to modernize your approach to COB:


  1. Use high-quality, continuously refreshed data.


The best information will always come directly from other health plans, not from the members themselves. It’s also important to use data that is continuously refreshed, preferably on a weekly basis. The more regularly the data is updated, the higher the likelihood that the member information is accurate. And, with almost one third of coverage overlaps coming from payers in a state other than the one where the member resides, having data from all 50 states is critical.


  1. Automate data ingestion as much as possible.


Having a trusted data source allows you to automate COB work and increase efficiency and cost savings. Along with reducing overpayments, automation saves staff time, reduces burnout, lessens the chance of human error and allows you to focus on other priorities. Autoloading COB data also standardizes the entire PI process by strengthening data accuracy across the board–not just for COB.


  1. Eliminate COB letters and reliance on members for coverage information.


Many plans still mail COB canvassing letters and rely on members to report overlapping coverage—even though they aren’t always the most reliable source for COB information. Additionally, COB letters are expensive, often have a low response rate and, if they are returned, usually have incorrect information. They can also create frustration for the members filling them out. Considering the cost and potential negative effects on the member experience, COB letters are generally an ineffective way to collect data. Working directly with other health plans takes the member out of the middle and drives better results.


To learn more best practices from health plans that have streamlined their COB strategy:


Download the issue brief