Improved Eligibility Determinations
When the public health emergency ends, Medicaid leaders will be required to perform eligibility redetermination for nearly 85 million people over a 9 to 14 month period of time.
The CAQH coordination of benefits solution provides programs a file every week with an analysis of coverage overlap of its enrollees. The analysis includes demographic and contact information, coverage types, plan names, dates of coverage and payer payment responsibility.
This information can then be used for a range of eligibility, benefit coordination, payment and enrollee outreach activities. For complex or undetermined coverage cases, payers have access to a secure payer-to-payer messaging system to share documents and resolve data or coverage issues.