Prospective Coordination of Benefits Overview

OptumInsight Prospective Coordination of Benefits helps reduce costs and eliminate administrative complexity by identifying and validating other insurance (OI) and determining the order of primacy for members prior to paying the claim.

Enrollment integrity
Our Enrollment Integrity service uses robust analytics to compare enrollment data from multiple health plans’ membership rosters to identify overlapping coverage.

• Incorporates a complete validation service
• Provides accurate other insurance and primacy determination
• Helps achieve proper claim payment

Accurate identification
Applying proprietary analytics techniques developed by biostatisticians, OptumInsight mines claims data and identifies cases that may involve potential coordination of benefits (COB) claims.

Smooth coordination
OptumInsight investigators work with other insurance carriers to apply workers’ compensation, automobile policies, and other coverage before the health plan addresses claims.

Prospective COB services identify other insurance prior to claim payment through targeted investigation and validation and include eligibility and primary verification via detailed analysis of eligibility, demographic, and historic claims data. This member-focused analysis enables us to identify each member and prevent errors before the claim is paid.