Software

Coordination of Benefits Solutions

A solution for commercial and government payers to optimize cost savings with accurate eligibility information and the proactive identification of undisclosed coverage prior to claim payment. 

IdentifyCoverage Earlier

  • Achieve 99% accuracy in verifying alternative coverage.1 Our nationwide eligibility data repository contains policy coverage across multiple policy types, driving unprecedented accuracy and savings for payers. 

  • Gain access to integrated medical, pharmacy, dental, and vision eligibility information updated daily and residing in a more secure cloud environment. 

  • Improve provider satisfaction by quickly delivering accurate primary coverage data prior to payment to avoid recoveries.
  • Identify undisclosed coverage prior to claim payment to help reduce the cost and time spent on retrospective claim analysis and payment recovery.

  • Streamline the recovery of improper payments for both state agencies and managed care organizations. 

  • Validate member status for Dual Special Needs Plans & Medicare Advantage Plans validate their members’ Medicaid status. 

Contain Costs Across the Payment Continuum

  • Prospectively drive accuracy

    • Proactively identify and validate member eligibility prior to claim payment to enhance your coordination of benefits strategy.
    • Identify coverage data matches quickly, efficiently, and accurately with our proprietary match algorithms.  
    • Capture more member matches with access to one of the industry’s largest data repository, updated daily and residing in a secure cloud environment.  
  • Pursue erroneous payments retrospectively

    • Streamline the recovery of improper payments with our Recovery solution.
    • Help ensure Medicaid agencies and their delegated entities remain the payers of last resort by identifying, billing, collecting, and reconciling improper payments.
    • Increase recovered payments and save an average of $12 PMPY in the first pass and $5 PMPY in the second pass.2 
  • Improve compliance with government programs

    • Validate members’ Medicaid status with our Member Management solution for Medicare Advantage and Dual Special Needs Plans. 
    • Ensure compliance with Centers for Medicare & Medicaid Services (CMS) by meeting the requirement to continuously verify dual eligibility for Medicaid members.
    • Drive member notification decisions and boost capitation reimbursements by applying the validated data on dual eligible members to your Dual Special Needs Plan enrollment process. 

Providing Measurable Value

99 %

accurate verification of alternative coverage1

$14

average PMPY increase in cost avoidance2

15+ %

average increase in recovered payments2

1. Change Healthcare internal statistics based on data for all customers using the Coordination of Benefits solution during a one-year period. Individual results may vary.
2. Ibid.

Our outcomes

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