CATEGORY: coordination-of-benefits

While the basic challenges to health insurance payment integrity remain largely the same – ensuring responsibility for the claim, the eligibility of the consumer, the coverage under the contract, the validity of the claim and the lack of fraud, waste and abuse – the range of factors that bear on those challenges has expanded over time. Fortunately, so have the capabilities of insurers to deal[…]

While coordination of benefits (COB) used to be a relatively simple, albeit time-consuming process of tracking down payments already made, the rise of big data, data analytics and machine learning have turned COB into a dynamic and high-reward opportunity for health insurers trying to improve payment integrity and reduce administrative overhead in today’s tightly-limited marketplace.

It’s common for more than one insurer to potentially have responsibility for paying a portion of a medical claim. When that happens, insurers go through a process known as Coordination of Benefits (COB) to determine which insurer pays what portions of the claim.