Industry experts estimate that about 7-10% of claims submitted to health plans require coordination of benefits – a significant portion of which result in secondary payers reimbursing providers for care that should have been covered by a primary payer. Despite the magnitude of this problem, preventing incorrect coordination-of-benefits payments and deploying efficient methods to manage and recover incorrect payments have proven difficult due to the significant labor and administrative effort required.

SCIOinspire’s MY COB application enables health plans to manage the entire COB identification, prevention and recovery process end-to-end. As a result, they improve savings and recovery from COB payments, reduce errors, increase productivity of already over-stretched COB departments, and enhance plan and regulatory compliance through audit trails and reports.

MY COB software is an analytics-enabled, automated solution built using the latest Microsoft.NET-based technology. Key components 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.

“Ensuring accurate and timely COB payments has long been a challenge for health plans,” says Lou Gianquinto, Senior Vice President, COB Services for SCIOinspire. “As member status and circumstances evolve, pertinent information does not always cross over from eligibility and enrollment systems into claims processing. There simply has not been an effective way to prevent erroneous COB payments and manage the process of recovering incorrect payments.”

With MY COB, health plans can recapture up to 20-30% more paid COB claims revenue than with conventional COB approaches, while improving productivity and compliance during the process, according to Gianquinto.

The functionality driving the MY COB solution was developed as the foundation for coordination of benefits services offered by SOCRATES, INC., now a SCIOinspire company. This is the first time the proven solution has been made available directly to health plans to run their internal COB programs. MY COB is available either as a software-as-a-service application or as a licensed application for internal hosting.

In addition, SCIOinspire offers a complete suite of COB solutions including:•COB Identify (identifying COB members and paid cases for recovery);

•COB Outsource (complete outsourcing of COB identification and recovery process);

•COB Audit (auditing of current COB process and claims).

“We are excited about offering MY COB to health plans,” notes Siva Namasivayam, Chief Executive Officer for SCIOinspire. “Healthcare administrative costs are under the microscope and health plans are seeking advanced tools to help control costs, reduce claims payment errors and protect their cash flow by avoiding unnecessary payments.

“We believe MY COB represents a practical and accessible solution that remedies a long-standing problem in the industry, and provides a measurable return on investment.”