A regional Blue Cross / Blue Shield health plan raised its coordination of benefits (COB) rate from 4 percent to 9 percent, reduced the instances it paid primary and increased the instances it paid secondary on claims.
The health plan had a well-established manual process for finding additional coverage for their members so the plan could perform coordination of benefits. They used a combination of member canvassing letters and data supplied retroactively by their recovery vendors. However, they suspected that they were still missing other coverage information and wanted to find opportunities for automation. To do so, they needed to find a more reliable, centralized source of data.
The plan selected COB Smart, a national, industry-leading prospective coordination of benefits solution that matches membership directly from health plans on a weekly basis to find coverage overlaps and make primacy determinations. To ensure that COB Smart could deliver additional data they were not uncovering through their current process, they compared the initial results found by COB Smart to the data they already had in their system from their manual process.
The plan decreased the instances where they would pay primary by 17 percent and increased the claims where they would pay secondary by 64 percent.”