Business Challenges
With a significant increase in dual income families and rise in aging population, the likelihood of individuals having multiple coverage's (private and Medicare) has also risen. This has made identifying and accurately coordinating health benefits (COB) more challenging. Payers who spend over $1 billion today in sanctioned claims are estimated to be losing $100 million every year on account of incorrectly identifying and coordinating their member's benefits.
This has put immense pressure on COB departments to accurately identify and process COB claims, and keep updated records of member information. However, this is easier said than done, as coordinating benefits requires the application of multiple rules and state specific laws, in an environment that often has disparate and constantly changing member & eligibility information. This is further complicated by the actively changing dynamics in the healthcare industry.
MY COB™ Identification and Case Management Application
MY COB™ is an Identification and Case Management Application that enables health plans to manage the entire COB identification, prevention and recovery process end-to-end. With MY COB, users can also manage the recovery of incorrect payments, while building comprehensive databases to prevent future incorrect provider reimbursements.
Health plans can update their member information more often, prevent unqualified reimbursements better, plug vital information gaps consistently, and recover more effectively; whilst reducing errors, increasing productivity, and improving regulatory compliance through audit trails and reports.
MY COB is powered by the latest Microsoft .NET-based technology; driven by a rule engine that derives logic from regulatory state specific NAIC, CMS standard, and Medicaid guidelines; and enabled by a robust case management system.
Key components of the MY COB system include:
- A data importer that collects claims payment information.
- A robust, customizable rules engine for identifying potential COB cases, which can be configured to reflect specific payer-specific and state COB guidelines.
- A module to manage member outreach.
- A configurable link to the health plan's eligibility database for updating member COB information.
- A case management module embedded with advanced workflow for managing the cases from creation to resolution and recovery. The module features specific components for compliance and audit purposes.
- A comprehensive reporting portal to track every aspect of the process, including savings and recovery reporting.
The platform is designed to coordinate all case activities and correspondence, through the use of diary dates and reminders. MY COB captures conflicting data and creates an intelligent multiple-option environment for resolution.
Additional Product and Services Information
MY COB™ Coordination of Benefits Identification and Case Management Application (Click here to download)
Press Release
July 1, 2009 : SCIOinspire Launches MY COB™, Coordination of Benefits Identification and Case Management Application (Click here to download)
