Cotiviti, a leader in data-driven healthcare solutions, is expanding its end-to-end Coordination of Interest (COB) solution by adding the potential COB authentication capabilities. This comprehensive service allows health plans to reduce overpayments by reviewing claims and determining payment liability after arbitration but before payment, making it the ultimate service provider. The only full-service “pause and pay” COB on the market.
The new upfront solution leverages advanced analytics to identify claims that require full COB review before a payment decision is made. By detecting nonconforming claims before they are paid, this approach improves supplier and member satisfaction by reducing the need to recover excess payments from suppliers. and minimize contact with health plan members.With COB validation, a major health plan customer has saved $40 million in nonconforming claims costs by 2022, including approximately $11 million in avoidance of billing errors before. By 2023, the plan is expected to avoid more than $60 million in COB validation billing errors, with upfront savings accounting for more than a third of that total. The combination of advanced analytics with advanced business rules and COB expertise allows a solution to deliver high accuracy, often with over 99% of complaints reported, ultimately for allows customers to avoid inappropriate payments. Cotiviti’s end-to-end COB validation solution supports both retroactive and prospective assessments of claims, giving plans a holistic view of each member in their own context.The comprehensive COB suite goes beyond rights-only data products, leveraging the company’s unparalleled data sets and rich expertise to seamlessly connect members with payers. With more than 20 years of COB experience and partnerships with five of the nation’s top six payments companies, Cotiviti continues to innovate prepayment interventions and help programs improve profitability, experience member experience and results through a suite of precisely integrated end-to-end payment solutions.“In coordinating member benefits, paying claims accurately while avoiding provider and member abrasion has become even more important following the end of the COVID-19 Public Health Emergency, which will result in benefit changes for millions of members moving from Medicaid to other payers,”
“Other market solutions only look at entitlement data, which is often incomplete, inaccurate, or outdated. As part of Cotiviti’s ongoing commitment to advancing claims payment accuracy, this prospective solution will further empower health plans to prevent inappropriate claim payments and will enhance the COB process for all stakeholders, including members and providers.”
Naomi Murphy, senior vice president, coordination of benefits and data mining for Cotiviti.
