Large National Health Plan Achieves $200M in Medical Cost Reduction with COB Smart
One of the nation’s largest health plans decreased administrative costs by more than $50 million annually and increased medical cost savings by $200 million for its commercial, Medicaid and Medicare Advantage business lines.
A large national health plan with multiple lines of business, knew they had a great opportunity to benefit from coordinating benefits with other payers. However, each line of business presented a different challenge, requiring a patchwork of outside vendors, multiple sources of data which varied greatly in quality, and considerable manual intervention. They sought a more efficient process that would enable them to identify and process COB data more quickly and with less administrative cost.
The plan began using COB Smart for their commercial, Medicaid, and Medicare Advantage lines of business. When they receive the COB Smart file each week, they autoload all validated data into their claims system and automatically set a COB flag so any claim that comes in for that member is processed as secondary. Their team then manually investigates any overlaps that did not pass validation, setting COB flags for those members after they have confirmed the information, or cleaning up their system if validation found an error. In addition, they have granted COB Smart portal access to numerous teams across the organization including COB Operations, Claim Operations, Pre-Pay and High Dollar Audit Operations, and Recovery Operations. These teams use the portal to quickly investigate member coverage and identify COB scenarios.