Coordination of Benefits Solutions

A solution for payers and TPAs who want to optimize cost savings with accurate eligibility information and proactive identification of undisclosed coverage prior to claim payment.

IdentifyCoverage Earlier

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Achieve 99% accuracy in verifying alternative coverage.

Our nationwide eligibility data repository contains policy coverage across multiple policy types, driving unprecedented accuracy and savings for payers and TPAs.1

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Improve provider satisfaction

Gain access to integrated medical, pharmacy, dental, and vision eligibility information updated daily.

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Deliver accurate coverage data

Identify undisclosed coverage prior to claim payment to help reduce the cost and time spent on retrospective claim analysis and payment recovery.

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Streamline recovery of improper payments

Take advantage of payer-initiated offsets and our reclamation program to streamline payment recoveries, even as you minimize your need for them.

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Coordinate benefits for dual-eligible members

Maintain payment accuracy by automatically validating member status for Dual Special Needs Plans, Medicare Advantage Plans, and other dual coverages.

Contain Costs Across the Payment Continuum

  • Accurately Drive Cost Avoidance

    • Proactively identify and validate member eligibility prior to claim payment
    •  Identify coverage matches quickly, accurately, and easily with our proprietary match algorithms
    • Maximize coverage insight by tapping into the industry’s largest repository of up-to-date data, updated daily and residing in a secure cloud environment
  • Pursue erroneous payments

    • Streamline recovery of improper payments with our recovery solution
    • Reclamation program ensures Medicaid payers and their delegated entities remain the payers of last resort by identifying, billing, collecting, and reconciling improper payments
    • More consistently and accurately identify primary coverages from alternative commercial sources and/or Medicare
  • Safeguard compliance with government programs

    • Our Member Management Solution validates members’ Medicaid status for Medicare Advantage and Dual Special Needs Plans
    • Ensure compliance with Centers for Medicare & Medicaid services (CMS) mandates by continuously verifying dual eligibility for Medicaid members
    • Drive member notification decisions and boost capitation reimbursements by applying validated data on dual-eligible members to your Dual Special Needs Plan enrollment process

Providing Measurable Value

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99 %

accurate verification of alternative coverage1

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average PMPY increase in cost avoidance2

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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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