Figuring out when members are covered by different types of insurance can be a struggle, or not even possible. It's a source of waste and confusion that some insurers are trying to root out.
The administrative inefficiencies of COB -- coordination of insurance benefits -- translate into $800 million of wasted spending, pretty much evenly split between payers and providers, according to Ann Brisk, business development manager at the Council for Affordable Quality Healthcare (CAQH).
All the sleuthing, back-and-forth correspondence, improper payment and lingering member coverage unknowns that come with benefits coordination should leave insurers with the goal of "doing it right the first time," Brisk argued in a presentation at the Health Plan Claims & Service Operations Conference in Boston.
For some time the nonprofit CAQH has been working to improve information exchange, via its CORE data sharing committee. Now, in a partnership with large insurers that include Cigna and WellPoint, CAQH is trying to tackle COB with COB Smart, an industry registry of membership data that health plans and providers can use to verify coverage and find overlaps.
CAQH and the insurers that launched the registry have three main objectives, Brisk said: identify individuals with overlapping coverage across multiple health plans; determine the correct order of benefits; and share accurate and complete information with appropriate providers and health plans.
COB can be one of those "known unknowns." No insurer really knows what members benefits are being improperly covered, or improperly covered by another plan, after the errors come to light.
"This approach is upfront and kind of proactive," Brisk said. "The world of recovery vendors is very different than this."
CAQH's registry of members, now in use by 12 insurers, has so far determined that 5 percent of the total membership has other coverage for a certain benefit, whether through a spouse's health plan or a public program.
"We focus a lot on cost-avoidance," said Sherri Murray, director of enterprise coordination of benefits at WellPoint. "The ASO groups," large self-funded employers, "are very focused on what the insurance company is doing for them to reduce costs. Part of that has to be identifying other coverage."
At the same time, Murray added, the goal of streamlining COB is ultimately accuracy. "There will be a percentage of the time where we will figure out that we're actually the primary payer."