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Case Study

How Proactive COB Data Saved a Regional Health Plan $69M+ in 16 Months

A regional healthcare provider and insurer in the northeast leveraged proactive COB data, secure payer-to-payer communication, and automated processes to reduce vendor spend by 70% and save $69M+ through more effective cost avoidance.

The Challenge

A regional healthcare provider and insurer in the northeast used a manual “pay-and-chase” approach to coordination of benefits (COB).

To manage this process, they relied on: 

  • 30 full-time staff members to make phone calls for every COB case 
  • Daily Medicaid data files from the state that were often inaccurate 
  • An outside vendor for recoveries that charged a per case fee 

This workflow was costly, labor intensive, difficult to manage and yielded inconsistent results.

The Solution

To transition to a more prospective and automated approach, the health plan leveraged validated COB data from CAQH.

After implementation, they received weekly files of coverage and primacy information with greater than 99 percent accuracy. They are also able to use this information to identify and recover incorrect claims payments where they should have been the secondary payer. 

The team also now has access to a portal which allows them to securely connect with other health plans to resolve complex coverage cases without having to reach out to the member or call the health plan directly. Given the new wealth of accurate and actionable member data, the COB team refined their workflow to increase cost avoidance and pay fewer claims incorrectly. 

The Results

Since implementing the CAQH COB solution five years ago, the health plan has seen a steady increase in savings, as well as a reduction in overpayment and vendor costs. With the addition of timely accurate COB data, they have been able to achieve: 
85 %


in manual data review

$ 69 M

in COB Savings

$ 1.04 M


from incorrectly paid claims in 16 months

70 %


in vendor spend in five years

Driving change with technology

CAQH solutions automate workflows, deliver a wealth of accurate and actionable data, and create a better experience for both providers and health plans.

Find out how better data can transform your directories.

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