How to Manage Medicaid Coordination of Benefits

How to Manage Medicaid Coordination of Benefits

It’s common for Medicaid users to have one or more other sources of healthcare coverage, and for that reason, the Centers for Medicare & Medicaid Services (CMS) created what is known as a coordination of benefits, or COB. In short, this determines who provides payment for healthcare first, second and so on, with third parties responsible for primary payment before Medicaid kicks in.

Because of the COB, health plan providers have a lot on their plate when determining which bills to send. The concept of cost avoidance – distributing payment requests to third parties before Medicaid – is now an industry-wide practice and must be performed in an effort to avoid the “pay and chase” action of recovering payment from third parties. With this in mind, health plan providers are encouraged now more than ever to search for other health insurance before having to make a cost-avoidance claim.

While finding Medicaid other health insurance is necessary, it can be time consuming for providers. Fortunately, advancements in health IT have created solutions that can streamline the identification process before payment is even needed. Programs now exist that can audit hundreds of thousands of users and determine if they have confirmed other drug and medical coverage. By doing this, you can avoid any issues with recovering payment from third parties, streamline your dealings with Medicaid and Medicare, and capture savings for both pharmacy and medical other insurance segments.

Services designed to identify other health insurance are also typically more efficient than traditional COB methods. Because electronic audits are seamless, some programs can identify up to four times the coverage segments. Without such systems, searching through the numerous data files of COB programs such as IRS/SSA/CMS Claims Data Match, Voluntary Data Sharing Agreements, COB Agreement, Initial Enrollment Questionnaire, among others, can prove far too time consuming to avoid all cost recovery efforts.

Dealing with Medicaid other health insurance is a necessity of modern health providers, and while time consuming, the process can be made simpler with help from health IT. To find out more about programs and solutions for your COB process, contact RxEOB today.