CATEGORY: coordination-of-benefits

With restricted margins and changing bargaining relationships as providers consolidate and evolve, health insurers are looking more than ever to coordination of benefits to improve their bottom lines. Fortunately, modern digital tools powered by big data analytics, artificial intelligence and machine learning have revolutionized COB for insurers by putting the patient, instead of the claim, at[…]

When it comes to IT, health plans face a quality problem. In fact, it’s less that they face one problem and more that virtually their entire business model generates challenges for the strategy, governance and operation of high-quality IT infrastructures. Getting it right requires expertise and effort that few other industries demand.

While the basic challenges to health insurance payment integrity remain largely the same – ensuring responsibility for the claim, the eligibility of the consumer, the coverage under the contract, the validity of the claim and the lack of fraud, waste and abuse – the range of factors that bear on those challenges has expanded over time. Fortunately, so have the capabilities of insurers to deal[…]

While coordination of benefits (COB) used to be a relatively simple, albeit time-consuming process of tracking down payments already made, the rise of big data, data analytics and machine learning have turned COB into a dynamic and high-reward opportunity for health insurers trying to improve payment integrity and reduce administrative overhead in today’s tightly-limited marketplace.

It’s common for more than one insurer to potentially have responsibility for paying a portion of a medical claim. When that happens, insurers go through a process known as Coordination of Benefits (COB) to determine which insurer pays what portions of the claim.