Coordination of Benefits Validation

Achieve greater accuracy from coordination of benefits determinations—both prepay and postpay

CMS RAC

Discover more in payment integrity


Healthcare payers are under constant pressure to deliver fast payment despite the system’s complexity. Managing infrastructure, improving healthcare accessibility and quality, perfecting hundreds of processes, and staying current on claims payment policies? It can be overwhelming. 

Cotiviti’s Coordination of Benefits Validation (COB Validation) solution delivers accuracy across the member journey. With both prospective and retrospective claim review, we see each member within their own context, and can offer validation at any point in the benefits coordination process.

100%
of surveyed VPs, directors, and managers of payment integrity at payer organizations agreed that Cotiviti stands out from the competition when it comes to time-to-value.*

 

We thoroughly review and analyze contracts, eligibility files, third-party benefits agreements, and other data sources to determine COB and payment responsibility. Our 20+ years of expertise in this specific area allows us to identify complex COB issues beyond any payment integrity vendors and programs that our clients may have in place. From this identification process, we build a store of comprehensive eligibility data and analytics that identify other commercial payer responsibilities.

 

With this solution, our clients benefit from:

95%

accuracy, with COB professional reviewers and data sources that validate findings before delivery

80%+

of overpaid findings are collected and realized as cost savings

$341M

saved by our clients in 2020, based on recovered overpayments

Coordination of Benefits Validation solution benefits and features

With Cotiviti, health plans get a combination of advanced analytics and clinically experienced professionals to review complex scenarios that often slip through audits. Improve accuracy and gain benefits that include:

  • Significant savings for all lines of business. Cotiviti provides a six sigma level of accuracy of 99.97% (measured by administering policy according to client wishes). Serving 90+ payers—including 21 of the top 25—means our services are familiar to nearly all networks.
  • Trustworthy expertise. Cotiviti serves five of the top six largest payers in the U.S., 14 managed Medicaid plans in 39 states, and 15+ Blue Plans. Validate claims against COB analytics developed, tested, and honed over 20+ years across multiple payers and all lines of business.
  • Analytically driven member section. Cotiviti’s enhanced analytics and sophisticated business rules allow us to focus on the 5–10% of members with the highest probability of other insurance.
  • Low total cost of ownership. Work with a solution that doesn’t break the bank. Cotiviti delivers high quality, low client burden, and competitive pricing.
  • Low impact to your membership. Cotiviti does not contact members to validate COB findings.
  • Significantly reduced administrative burden. Integrated recovery management and appeals include findings validation, offset management support, recovery management, and at least first- and second-level appeals support.

*Source: TechValidate. TVID: 3A1-FC0-C4E

Work with a partner that values context

With more than two decades of experience in the coordination of benefits, Cotivti understands the value of context when it comes to coordinating benefits. We see members as people and value the context of their lives within the claim lifecycle. We know that people’s lives change, and Cotiviti is adaptable to these changes. We offer flexible solutions that solve for the most nuanced benefits claims and meet health plans where they are—whether that’s prepay or postpay.


Discover more in payment integrity

Ready to learn more? Talk to one of our sales representatives—fill out the form below to schedule a call.