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. 

Identify Coverage 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. 

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

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

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

Improve provider satisfaction by quickly delivering accurate primary coverage data prior to payment to avoid recoveries.

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.

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

$14.42

Average PMPY increase in cost avoidance2

15-20%

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.

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