Government-sponsored healthcare programs are critical lifelines for their members. The time period following enrollment is often a high utilization period where new recipients seek out necessary health services. Having the ability to identify other coverage for these new recipients at the point of enrollment offers significant advantages to all program stakeholders.
- Health plans avoid costs that are the responsibility of the third-party payers; and reduce the administrative burden of pay-and-chase claims.
- Recipients receive improved benefits and continuity of coverage, especially where managed care decisions are in part based on the existence of other coverage.
- Healthcare providers gain earlier access to insurance data, enabling them to realize higher payments from recipients who have access to commercial coverage. COB on Demand does not replace but enhances existing Coordination of Benefits (COB) efforts. Those identification and verification initiatives remain necessary to capture coverage changes post enrollment.
COB on Demand is designed for programs that have secondary payer or payer of last resort status including Medicaid, the Children’s Health Insurance Program (CHIP) and AIDS Drug Assistance Program (ADAP).
Application and Compliance
- COB on Demand may be delivered through an API connection facilitating interoperability with Medicaid Enterprise Systems and other enrollment and claims management systems. It is also available through a User Interface or rapid batch process.
- COB on Demand is operated in HMS’s secure environment that meets or exceeds state and federal healthcare data security standards. HMS is HITRUST certified.