Case study: Prepay COB boosts payment integrity results for large national payer

One of the most critical aspects of using analytics in coordination of benefits (COB) is the ability to pause and review claims before payment. This proactive approach involves temporarily holding claims for a detailed review to verify their accuracy and ensure correct assignment of payment responsibility. By intervening at the right time, health plans can prevent overpayments, reduce future erroneous payments, and confirm that primary payment responsibility is correctly assigned, all while lowering provider abrasion.

After partnering with Cotiviti for more than 20 years to build a payment accuracy program—including prepay claims editing, postpay data mining, and DRG review auditing—a large national payer with millions of Medicaid, Medicare, and commercial members added Cotiviti’s prepay pause-and-review process to its retrospective COB program in 2020.