A Prospective Approach to Coordination of Benefits Yields $1.1 Billion in Savings
A large, highly regarded health plan serving states in the mid-Atlantic region streamlined COB processes and reduced spend on recovery vendors, saving more than $220 million annually.
The health plan was experiencing many common coordination of benefits (COB) challenges: high vendor costs, internal resources tied up on COB operations, slow processing times and a low percentage of recovery.
Because the plan was also experiencing 14 percent year-over-year growth, improving its approach to COB became an urgent goal.
After conducting a marketplace review of a variety of COB technologies and services, the plan selected COB Smart, the national, industry-leading coordination of benefits solution from CAQH.
COB Smart uses a unique prospective approach to benefits coordination. Every week, participating payers send up-to-date eligibility information to COB Smart, which uses advanced algorithms to find matches in the system. COB Smart then supplies plans with information about overlaps so they can identify primary and secondary coverage and determine primacy before they pay claims.