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.
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
Improve provider satisfaction
Gain access to integrated medical, pharmacy, dental, and vision eligibility information updated daily.
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.
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.
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
accurate verification of alternative coverage1
average PMPY increase in cost avoidance2
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.
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