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 apply artificial intelligence, machine learning, advanced analytics, and specialized expertise to thoroughly review and analyze plan documents, eligibility files, third-party benefits agreements, and other data sources to accurately 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. Through this identification process, we build a comprehensive repository of eligibility data and analytics that accurately identify other commercial payer responsibilities.
With this solution, our clients benefit from:
>38%
additional medical cost savings beyond internal teams and vendors
>99%
of findings are sustained
$945M
saved by our clients in 2025, including specialty drugs covered under medical benefits
COB Validation solution benefits and features
With Cotiviti, health plans get a combination of AI/ML, 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 regardless of plan size or existing payment solutions. COB Validation delivers an additional >38% savings beyond internal teams and other payment integrity vendors. Clients can further increase 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 advanced 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 outcomes with minimal client burden and competitive pricing.
- Minimal member disruption. Cotiviti does not contact members to validate COB findings.
- Significantly reduced administrative burden. Integrated recovery management and appeals include findings validation, offset management support, and at least first- and second-level appeals support.
