Regional Plan Success: Second-Pass COB Results

Health Plan Achieves $2.5 Million in Savings with Advanced COB Validation

A regional health plan has realized notable financial gains by partnering with Cotiviti to streamline its Coordination of Benefits (COB) process. The plan’s implementation of Cotiviti’s retrospective COB Validation solution has already generated $2.5 million in savings year-to-date, with a projected $3.7 million in savings by year’s end.

The COB process, ofen described as intricate and time-consuming, involves verifying data, establishing claim primacy, and ensuring accurate payment across multiple insurance plans. Recognizing the complexities, the health plan initially leveraged Cotiviti’s prepay Payment Policy Management and Coding Validation solutions before deploying COB Validation in 2024 for both commercial and Medicaid lines of business. This deployment functioned as a crucial second-pass review, designed to identify issues that initial assessments might have missed.

Did you know? – Coordination of Benefits (COB) ensures that healthcare claims are paid correctly when a patient has multiple insurance plans. This prevents duplicate payments and maximizes cost savings.

“Having a seasoned partner to cut through complexities for speed, accuracy, and detail can mean significant savings,” a company release stated.

The results have been striking. Cotiviti quickly identified findings exceeding initial estimates by more than 200%. Within just one month of receiving the initial COB Validation data, the client reported savings exceeding $650,000. The program has consistently maintained a high yield rate, averaging 90%, with peak months reaching 98%.

Key benefits realized by the health plan include deeper,second-pass findings,immediate savings upon implementation,and high-quality results that translate into substantial financial recovery. Cotiviti’s solution has proven particularly effective in identifying savings related to specialty drugs covered under medical benefits.

Reader question: – How can health plans ensure the accuracy of their COB processes? What are the biggest challenges in managing COB, and how can they be overcome? Share your thoughts.

Cotiviti’s success is built on over 20 years of experience and a proven track record, having already saved its COB Validation clients over $805 million in 2024. The company differentiates itself with its unique “pause-and-review” COB solution, offering a holistic approach to claim payment accuracy regardless of plan size or existing payment systems.

According to a company release, Cotiviti’s approach delivers 30% additional medical cost savings compared to internal teams and other vendors. The solution promises not only increased cost savings but also reduced administrative burden and improved member experience.

This case study underscores the growing importance of advanced COB validation as a critical component of financial integrity for health plans navigating an increasingly complex healthcare landscape.