Determine Claim Responsibility

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

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COB Validation is part of Cotiviti's
Payment Accuracy solution suite.

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Coordinating benefits determinations is challenging for health plans. Acquiring valid and accurate member data to coordinate benefits in a timely manner can be complicated and can result in overpayments due to information gaps between members, providers, employers, and payers.


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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.*

Cotiviti's 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.

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:

>30%

additional medical cost savings beyond internal teams and vendors

>98%

of findings are sustained

$805M

saved by our clients in 2024, including specialty drugs covered under medical benefits

 

COB 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. Get reliable validation on the coordination of benefits, no matter the size of your business or your current payment solutions. COB Validation delivers an additional >30% savings beyond internal teams and other payment integrity vendors. And clients can expect a 10–20% increase in program value by adding prospective COB validation.
  • Trustworthy expertise. Cotiviti serves 40 health plans, including 9 of the top 10 largest payers in the U.S. and nearly 20 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.


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