Coordination of benefits (COB) is a long-standing insurance practice that ensures the most appropriate payer is paying for services when a patient has more than one insurance plan. COB information is often inaccurate, causing significant delays in processing of medical claims. In the pharmacy world, however, claims are processed in real time. This means that payers are forced to assess third party liability after the pharmacy claim is processed and paid. This “pay and chase” approach is notoriously slow, resource-intensive and ineffective. In fact, it is estimated that only 17% of these dollars are actually recovered, leaving a staggering 83% unrecovered.
Aside from budgetary issues, safety is a concern. When there are multiple payers processing prescriptions for the same patient, there is increased likelihood of missing safety alerts. Catamaran’s enhanced COB replaces the pay and chase approach by identifying other insurance and avoiding the cost of claims where there is liability. This frees up resources to focus on important healthcare challenges and goes directly to the payer’s bottom line. In a little over 12 months, Catamaran has saved its customers nearly $30M and projects to save them almost $100M in the next 12 month period.