A regional healthcare provider and insurer in the northeast leveraged proactive COB data, secure payer-to-payer communication, and automated processes to reduce vendor spend by 70% and save $69M+ through more effective cost avoidance.
A regional healthcare provider and insurer in the northeast leveraged proactive COB data, secure payer-to-payer communication, and automated processes to reduce vendor spend by 70% and save $69M+ through more effective cost avoidance.
To manage this process, they relied on:
This workflow was costly, labor intensive, difficult to manage and yielded inconsistent results.
After implementation, they received weekly files of coverage and primacy information with greater than 99 percent accuracy. They are also able to use this information to identify and recover incorrect claims payments where they should have been the secondary payer.
The team also now has access to a portal which allows them to securely connect with other health plans to resolve complex coverage cases without having to reach out to the member or call the health plan directly. Given the new wealth of accurate and actionable member data, the COB team refined their workflow to increase cost avoidance and pay fewer claims incorrectly.
Since implementing the CAQH COB solution five years ago, the health plan has seen a steady increase in savings, as well as a reduction in overpayment and vendor costs. With the addition of timely accurate COB data, they have been able to achieve: