Six Signs of a Comprehensive Coordination of Benefits Solution

January 6, 2022

There are many coordination of benefits or COB products currently available on the market. However, few offer a comprehensive, integrated solution. It can be challenging to navigate the solution selection process, so we’ve outlined below six characteristics that point to a comprehensive COB offering:

  1. Robust data. The coordination of benefits process is driven by data. As a result, limited information can reduce savings and recoveries. Regular maintenance of known third party liability (TPL) data is essential. High-quality TPL information assures healthcare organizations that they won’t be risking member or provider abrasion. Streamlined management of all other health insurance (OHI) sources is also critical. Verified, normalized and comprehensive OHI data enables healthcare organizations to understand the full scope of member benefits and promotes improved quality of care. Reliable OHI data helps payers to reduce the administrative burden and overhead associated with consistently maintaining data quality from multiple information sources.

What to look for in a COB solution? Try to find a partner that creates data use agreements with payers across plan types. The result is a comprehensive set of information that can be used to identify all coverage sources. This can also improve algorithms used for match logic and overall COB accuracy.

  1. A prospective focus, rather than a primarily retroactive approach. Post-payment recovery will always play a role in COB due to mandatory pay and chase requirements and retroactive eligibility. Adding in pre-payment cost avoidance, however, results in higher savings and lower administrative costs.

What to look for in a COB solution? Seek out solutions that offer integration and coordination between pre-payment and post-payment COB components to avoid gaps.

  1. Integrated COB processes. Integration of patient health data across systems and settings is the key to identifying all available health benefits and coordinating care. Leading COB programs focus on widespread coordination, communication and data exchange.

What to look for in a COB solution? Keep an eye open for solutions that offer interoperability and stakeholder-friendly processes designed to minimize silos and maximize COB efforts.

  1. Smart use of technology throughout the COB process. This is essential for accurately detecting and verifying other primary payers in real-time. Key technologies include advanced data mining, data matching and analytics. Leading COB solutions identify claims with the highest likelihood of recovery using machine learning technologies that analyze and target claims based on characteristics like claim type, employer group, and procedure code. It’s also important to automate the processes for identifying the root cause of denials and for facilitating corrective action. With technology, proactive COB systems can analyze, correct and resubmit rejected or inappropriately paid claims until third parties have been correctly paid.

What to look for in a COB solution? Look for products that leverage big data for longitudinal analysis of member data. With carrier response files, it’s possible to apply analytics and create longitudinal case histories for members that identify coverage date ranges and support post-payment recovery of claims from liable third parties.

  1. Actionable analytics that drive improved outcomes. COB program maintenance and monitoring are critically important. For example, when claims and COB data are integrated together in reporting, organizations can ensure that OHI is being maximized. Benchmarks are also a good idea to quantify program performance and to track trends over time.

What to look for in a COB solution? Keep an eye open for visibility into key performance drivers and reporting. With this information, organizations can identify emerging trends and implement more proactive strategies and decision-making.

  1. A strong member and provider-community support structure. Strong payer-provider relationships allow for more effective coordination and prevent erroneous payments on more complex cases. Online portals can facilitate two-way communication between plans and providers. These tools should make it easy to review and submit claims, as well as COB information and additional data electronically. If outdated OHI is causing issues at the point of sale, a call center is imperative for handling escalated member situations and ensuring that members get the care they need.

What to look for in a COB solution? Seek out a system that’s designed with end users in mind and that minimizes provider impact, while accelerating recovery cycles.

There are many COB solutions out there, but they are not all created equal. HMS, A Gainwell Technologies Company, offers a comprehensive portfolio of COB options. We’d love to learn more about your needs and to help in any way we can. Feel free to contact us.

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