| The news
Cotiviti, a healthcare infrastructure company, launched a new AI-powered coordination of benefits solution on Thursday to support payers. The issue
Salt Lake City-based Cotiviti offers solutions to increase transparency and collaboration between payers and providers. The new solution, called Proactive COB, is meant to support payers and providers at the time of member enrollment. Coordination of benefits is the process insurance companies use to determine how to cover medical expenses when a person is covered by more than one health plan. It determines who pays what by understanding which plan is the primary payer and which is the secondary. Errors with coordination of benefits typically occur when a member changes coverage due to life changes like switching jobs, retiring, getting married or having a baby. “Any of those changes can change the order of the benefits,” said Matthew Herbein, vice president of product at Cotiviti, in an interview. “What that means is, if you go to a healthcare provider and you have multiple health insurances, well, that provider has to kind of understand which one to bill as primary, and then which one to maybe bill as secondary to cover your member responsibility. The issue at hand is that data is very fragmented.” When people enroll in new coverage, health plans often don't receive complete or accurate coverage information. Therefore, errors can go undetected until after claims are paid, leading to costly recovery efforts and added administrative work. The solution
Cotiviti’s Proactive COB addresses these issues by identifying and validating when a member has other health insurance and determining the correct order in which benefits should be paid. It relies on member enrollment data rather than waiting for a medical claim to be submitted to identify coordination of benefits issues. — By Marissa Plescia |
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