Coordination of Benefits

Analyze more members to maximize recoveries

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Identify more instances of other insurance

Your health plan’s success is based on the speed and accuracy of claims payments. However, when your claims team and systems don’t have updated or accurate eligibility information, you can end up paying too much for some claims and paying some claims that you weren’t responsible for—all leading to a significant blow to your bottom line. Industry research shows up to 10% of all health plan members have other insurance coverage in any given year, which can cost your plan millions in higher payouts and administrative work. 

Discovery’s Coordination of Benefits (COB) solution is designed to work in partnership with your in-house teams. Our COB experts identify instances of other coverage in order to maximize recoveries and drive future cost avoidance for you. We complement your team and existing processes using unique data mining and analytics to identify recovery opportunities that may have gone undetected. We validate coverage status, recover claims paid in error, and deliver updated eligibility data—all with a proven, holistic approach that maximizes recoveries for your health plan and minimizes provider, member, and plan sponsor abrasion.

The latest in Coordination of Benefits

eBook

The modern guide to COB

Advances in data integration, predictive analytics, and machine learning offer the tools health plans need to streamline their COB processes—in a way that improves payment recoveries while minimizing any impact on the member and provider.

Ways we help

Analytics

The cornerstone of our COB solution, our data mining, modeling, and analytics help us identify members with the highest potential for other coverage and recovery.

Expertise

Our COB solution supports all lines of business—Medicaid, Medicare, and commercial—because we have a comprehensive understanding of the rules specific to each coverage type. 

Sensitivity

Knowing that member experience is a top driver of plan satisfaction, we make sure that all COB activities are done with as little member engagement as possible.

Better results from identification and validation through recovery

 

Improved identification

The first step in COB is identifying members with the highest probability of other coverage. Our rules-based analytics identify, for example, a member over 65 who may be on Medicare. Beyond that, predictive analytics and machine learning analyze multiple factors such as age, demographics, and disease categories to more accurately pinpoint instances of other coverage.

 

Positive member experience

Creating a positive member experience is key to your success with COB. We understand member satisfaction is a critical concern for your health plan, so we work to obtain as much information as possible without engaging the member. When we do reach out to your members, it’s as easy, sensitive, and friendly as possible.

 

Updated eligibility data

A key component of COB is avoiding inaccurate claim payments in the first place. Our sophisticated data integration and analytics capabilities quickly and accurately identify claims that are not your plan’s responsibility—and resolve the issue before you pay.

 

Proactive cost avoidance

Cost avoidance begins with accurate and updated eligibility data. Using accurate and current eligibility information, we facilitate recoveries of claims that were the responsibility of another payer and ensure payments are made accurately today and in the future. 

 

Solution overview brochure

Discovery’s data mining, modeling, and analytics capabilities are the cornerstone of our COB solution. Our data mining process utilizes multi-dimensional data modeling that integrates several critical data elements to identify members with the highest potential for other coverage and recovery.

Your Coordination of Benefits partner

Recover and restore value to get the revenue you deserve and make healthcare more affordable.

 

Prevent

Transition from pay and pursue to pre-pay cost avoidance

 

Correct

Update eligibility data to pay accurately going forward

 

Recover

Identify more high-value opportunities

Contact us today for more information on accelerating your payment integrity results

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Discovery Health PartnersCoordination of Benefits