At any given time, between 8-15% of a health plan’s membership is covered by another plan, resulting in incorrect eligibility information that could be costing your plan millions in incorrect payments, time, and resources.
Disparate data, siloed information systems, and multiple moving parts all contribute to incorrect eligibility information and improper payments. To identify instances of other health insurance, your plan needs access to multiple data sources and the ability to verify state, CMS, and CAQH data—all of which add more time and resources. Even if done correctly, there is still a chance your plan is leaving money on the table. So what can you do and how do you find the right partner to supplement your team?
Choosing the right partner has never been more important or more daunting. A growing number of vendors claim to use leading-edge technology such as data mining, artificial intelligence, and machine learning. But what does this mean to you and your health plan?
To help you choose the right COB partner, here are some key factors to consider:
- Data: Where is the potential vendor getting its data and is the data relevant to your plan?
- Expertise: What type of clients does the COB vendor work with today? Are they specialized in one line of business or do they work across multiple? Does the vendor have folks with plan-side experience?
- Satisfaction: Does the vendor have a track record of delivering value to its clients?
- Flexibility: Is the vendor flexible enough to wrap around your current team? Or are they inflexible to change?
- Technology: Is the vendor using cutting-edge technology—like AI and machine learning—to look at eligibility more holistically?
- Research and development: Is the vendor relying on standardized practices that “worked before”? Or do they have a team of seasoned research analysts dedicated to looking for new rules, regulations, data sources, and data points to deliver additional value?
- Full-service capabilities: Does the vendor offer solutions spanning all phases of the claims lifecycle (e.g., prospective, retrospective, hospice, etc.)?
- Security: Is the vendor HIPAA and HITRUST compliant? What security standards and access policies are in place?
- Partnership: Is the vendor willing to learn about your organization, what’s important you, and how to support your COB process and goals? Is this a joint collaboration and journey? Where does you plan line up with the vendor’s other clients? Will you be a priority for them?
To learn how Discovery Health Partners can help support your COB initiatives, visit our Coordination of Benefits solution page or open up the contact form to the right.