Large National Health Plan Achieves an 80:1 ROI with COB Smart
One of the nation’s largest health plans decreased administrative costs by more than $4 million annually and increased medical cost savings for its commercial, Medicaid and Medicare Advantage business lines.
A very large national health plan with multiple lines of business knew it 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 data that 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, a national, industry-leading prospective coordination of benefits solution that matches membership directly from health plans weekly to find and validate coverage overlaps, 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 the plan has the data they need to process claims correctly.
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 using the COB Smart portal to change the data in their internal system if validation found an error. In addition, they have granted portal access to operations teams across the organization including COB, claims, pre-pay and high-dollar, and recovery. These teams use the portal to quickly investigate member coverage and identify COB scenarios.