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.
2018 has been a year of significant change for COB teams at health insurers, and some trends are sure to accelerate:
From reaction to prediction
The core of data analytics-driven COB is the ability to move from a reactive to a predictive model through scoring tools that help insurers identify situations where the COB process applies. Working with a combination of internal and third-party data sets, analytics can predict with reasonable reliability which consumers are most likely to have insurance through other third party coverages, creating potential savings for the insurer.
Increasing claims adjustment integration
While COB has always worked hand-in-hand with “Fraud, waste and abuse” (FWA) claims adjustment functions, the same ability to identify trends, refine scoring to predict behavior and tease out the connections between previously-unconnected data points make both functions far more efficient. The same analysis and scoring that help identify someone with a higher likelihood of having third-party insurance can be applied to likely indicators of potential fraud or abuse.
Knowing more about customers
Data analytics tools increase in effectiveness as the quality and breadth of the data with which they work improves. This is why insurers will continue to invest both in broadening the scope of the data they can access about consumers, as well as increasing the depth of their understanding about their own policyholders. Insurers will integrate consumer-facing activities such as wellness management and loyalty marketing into COB and payment integrity functions, generating data that will proactively improve an insurer’s understanding of their policyholders not only for marketing and utilization purposes but also to inform COB scoring.