Coordination of Benefits & Eligibility

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Performant Healthcare Solutions' COB data mining solution is designed to recover and help prevent leakage by identifying and correcting communication breakdowns between employers, health plans, and governmental entities. COB data mining can drive significant savings for health plans with little effort from the plan to:

  • Validate member information, group size, and employment information
  • Coordinate information with Section 111 and response files while looking for commercial coverage and claims data to ensure proper adjudication
  • Identify other insurance information with CMS for Medicare Advantage claims

Even plans with mature programs and large COB teams struggle with changes at the group and member levels that alter (or flip) Medicare from secondary to primary, once Medicare information is known, due to group management, working status changes for subscribers, and incorrect dual eligibility coordination. Leveraging our powerful analytics platform and team of data mining experts, Performant offers full-service assistance on the front end to address typical obstacles through a balanced combination of technology, analytics, algorithms, and manual processes. These processes expedite findings and drive savings on the front end quickly and efficiently.