Coordination of Benefits
Aim to maximize recoveries and prevent future overpayments with adept data modeling and rules-based analytics.
Coverage Accuracy
Cost Avoidance
Creating COB clarity to help improve recoveries while working to drive future cost avoidance and minimize abrasion.
When members have more than one health plan, determining who pays first can quickly become complicated and mistakes are easy to make. Claritev’s Coordination of Benefits solution helps validate that claims are paid accurately and fairly by identifying overlapping medical and pharmacy coverage, confirming the correct primary and secondary payers, and helping to prevent duplicate payments before they happen.
Using a thoughtful blend of advanced data analytics and experienced human review, we bring clarity to complex coverage situations while helping to keep provider and member disruption to a minimum.
The latest in Coordination
of Benefits:
The modern guide to COB
Advances in data integration, predictive analytics, and machine learning are the tools health plans need to help streamline their Coordination of Benefits (COB) processes with the goals of improving payment recoveries and minimizing impacts on the member and provider.
Coordination of Benefits expertise that can make a bottom-line difference.
Our end-to-end COB solution supports both prospective and retrospective reviews and can deliver reliable results across all lines of business. We use data modeling and rules-based analytics to pinpoint the highest recovery and cost-avoidance opportunities and then validate each finding through trained auditors with deep COB expertise.
The result is a flexible, provider-and member-friendly approach that can deliver 94% COB accuracy
that can enable measurable recoveries, which can help health plans reduce financial leakage and build confidence in payment decisions.
Transparency across touchpoints.
Claritev’s data mining process, modeling expertise, and analytics capabilities can bring results into focus, like:
Improved Identification
Rules-based and predictive analytics come together with machine learning to identify instances of other coverage.
Positive Member Experiences
We take a judicious approach to member engagement by aiming to accomplish as much as possible without member participation. When intervention is needed, we work to make it easy.
Updated Eligibility Data
Our sophisticated data integration and analytics capabilities can quickly and accurately identify claims that are not your plan’s responsibility and inform clients of primary coverage to avoid future overpayments.
Proactive Cost Avoidance
Using accurate and current eligibility information, we can facilitate recoveries on claims that were the responsibility of another payer and help facilitate accurate payments today and in the future.
Engaging insights.
New ideas, proven best practices, and fresh perspectives for the healthcare ecosystem.
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How can Claritev help you validate healthcare coverage with the goal of maximizing recoveries?
Learn how Claritev can help maximize recoveries and prevent overpayments with data-driven solutions.