ROLLING MEADOWS, IL (June 27, 2012) – Discovery Health Partners, a provider of intelligent, cloud-based healthcare cost containment solutions, today announced that it has integrated Medicare Secondary Payer Validation and Medicaid State File Validation to its core Supplemental COB services – further enabling health plans to save in paid claims, avoid unnecessary cost, and improve the integrity of their eligibility files.
Medicare Secondary Payer (MSP) Validation examines open MSP records for Medicare Advantage organizations to ensure that premium revenue generation opportunities are maximized. Medicaid State Eligibility File Validation confirms the validity of other coverage information collected by the state through its mandatory reporting. Now Discovery Health Partners’ Supplemental COB services utilize all relevant information—eligibility, claims, MSP, Medicaid State Eligibility Files, Query Only (HEW) Input files, and annual COB surveys – to enhance data mining and speed the process of identification, proper coordination, recovery, and eligibility system updates.
“As costs for employee medical insurance continue to grow, more health plans are adding supplemental COB services to their cost containment strategies,” said Paul Vosters, President of Discovery Health Partners. “Up to 10% of claims have coordination potential. We have a rich history as data experts and management consultants to augment internal COB programs.”
Section 111 reporting requirements have escalated the number of open MSP occurrences for Medicare Advantage organizations. This drives an increased number of premium adjustments – many of them invalid – that negatively impact a health plan’s revenue stream. Additionally, the information Medicaid MCOs receive from the state often contains outdated and inaccurate information; it is challenging to load such data into eligibility systems without overriding recent updates with erroneous information. Medicaid State Eligibility File Validation updates eligibility files with accurate coverage information, and ensures that claims are paid timely and accurately and overpaid claims are quickly identified and recovered.
Three software-as-a-service (SaaS) applications support Discovery Health Partners’ Intelligent COB solution: Discovery Identification℠ uses sophisticated data mining to accurately identify opportunities to coordinate benefits and generate cases for investigation. Discovery Case Manager℠ manages the COB process by housing all data and activities associated with each inventoried case. Discovery Dashboard℠ provides interactive analytical features for complete transparency and customized trend and case reporting.
“Staying on top of complex COB rules is our specialty. By utilizing our expertise in COB, we free up a health plan’s resources to focus on quick and accurate claims payment,” said Laura Cohen, Director of Client Advocacy and Coordination of Benefits Operations. “Our COB solutions blend technology, process improvement and workflow automation so all health plan member populations — Commercial, Medicare, and Medicaid – will no longer lose claims payment revenue due to poor data.”