Retrospective Coordination of Benefits Overview

Retrospective Coordination of Benefits (COB) helps contain costs by using analytics to identify and validate other insurance, determine the order of primacy for members, and then recover overpayments.

If a claim has been paid and is later determined to be the responsibility of another plan, we apply proven recovery techniques to help you recover the money, save costs, and prevent future errors through root-cause analysis.

Our retrospective COB solution comprises several strategies:

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

Data mining services
Through advanced analytics, OptumInsight experts scrutinize paid-claims data to identify overpayments when other insurance (OI) should have been applied.

Overpayment recoveries
OptumInsight provides complete business process outsourcing to help you recover overpayments. Our three-tiered approach includes traditional collections via correspondence and phone calls, direct assistance from an on-site recovery specialist, and a web portal connection.

The OI information is updated in the health plan’s system to avoid future overpayments.