Coordination of Benefits Solution for Health Plans

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Software

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.

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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

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

99 ^%

accurate verification of alternative coverage¹

$14

average PMPY increase in cost avoidance²

15+ ^%

average increase in recovered payments²

^{_{1. �糵�� 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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We Deliver So You Can. The Streamlined Patient Communications Solution

Infographic

We Deliver So You Can. The Streamlined Patient Communications Solution

Learn how a platform for the full spectrum of patient communications accelerates revenue, lower cost-to-collect, reduce bad debt and boost the patient experience.

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