With a significant increase in dual-income families and the average age of Americans rising, the likelihood of individuals having multiple benefits plans has also grown making the identification and coordination of health benefits (COB) more challenging. An effective COB program can achieve a 5% savings through avoidance and 0.5% in recoveries roughly $5 million for a 500K life plan.
MY COB users can manage the recovery of incorrect payments more efficiently and effectively and automatically develop comprehensive databases to prevent payment of future COB claims.
MY COB enables health plans to manage the entire COB identification, prevention and recovery process end-to-end in order to:
In fact, health plans can recapture up to 20-30% more paid COB claims revenue than with conventional COB approaches, while improving productivity and compliance during the process.
Healthcare payers are struggling with:
Powered by the latest Microsoft .NET-based technology, MY COB features an advanced rules engine that derives logic from regulatory state specific NAIC, CMS standard and Medicaid guidelines. With this robust technology at their fingertips delivered via SaaS or licensed for internal hosting health plans can update member information more frequently, prevent unqualified reimbursements better, plug vital information gaps consistently, and recover more effectively all while reducing errors, increasing productivity, and improving regulatory compliance through audit trails and reports.
MY COB relies upon an advanced data importer to collect claims information. The application identifies potential COB cases by processing claims data through a robust, customizable rules engine. Eschewing a typical blanket approach, SCIOinspire targets a prioritized list of members with selection factors including:
Member outreach is then initiated using a variety of methods such as outbound calls and paper questionnaires. When member responses are received, MY COB applies NAIC and MSP rules for validation. Subsequently, the application:
