We help you streamline benefits coordination
Health plans face many challenges when trying to identify and validate primary policy coverage, including:
- Time, staffing and budget constraints
- Lack of access to timely and credible eligibility records from other insurers
- High administrative costs associated with member attestations and staff validations
- Reliance on abrasive post-pay recovery and Medicaid reclamation rather than cost avoidance
But inaccurate coordination of benefits can be costly and often leads to higher administrative and medical costs as well as member and provider abrasion. Optum® Coordination of Benefits delivers accurate eligibility data to identify and validate primary coverage as soon as member enrollment.
Key benefits
We prospectively and retrospectively identify and validate primary coverage, reducing rework, costs and provider abrasion.
Determine eligibility with advanced analytics
Using machine learning models and our best-in-class eligibility data lake, we can coordinate benefits as soon as member enrollment.
Validate matches with human expertise
Potential policy matches are validated by Optum subject matter experts with over 99% accuracy.
Avoid future overpayments
We notify clients as soon as other primary coverage is confirmed, enabling them to avoid future overpayments.
Unparalleled eligibility data for improved benefits coordination
With eligibility records across medical, dental, vision and pharmacy policies, our data lake is the most comprehensive in the COB industry. Data is refreshed daily enabling Optum to identify members who have other primary coverage with efficiency and more than 99% accuracy. This enables health plans to immediately update their eligibility systems and prevent future overpayments.
Related healthcare insights
E-book
Learn how to create a framework that drives payment accuracy on the first pass.
Video
Learn how a flexible editing program can help your plan solve editing challenges, enforce policies, improve accuracy and increase savings.
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Cost containment across the payment lifecycle
Coordination of Benefits helps health plans maximize savings at every stage in the payment lifecycle.