Coordination of Benefits

PAYER RELATIONSHIPS & ONBOARDING SUPPORT

While we can access payer records through clearinghouses and third parties, our priority is building direct partnerships with payers. Why? Because going straight to the source ensures unparalleled accuracy, efficiency, and reliability in every transaction.

• Ensure data accuracy and security by implementing effective onboarding with extensive quality testing and secure file transfers, giving you confidence in every data exchange. 
• Simplify submissions for payers by adapting to their preferred file format, reducing workflow disruptions, and expediating data delivery. 
• Our ongoing collaboration ensures seamless HIPAA-compliant billing and adherence to state-specific regulations. 
• We’ll accelerate reimbursement by eliminating delays and inefficiencies to optimize revenue cycle management, helping you get paid faster for third party-covered services.

COVERAGE LEAD IDENTIFICATION 

Bulk up your cost avoidance efforts and reduce access to care issues for beneficiaries by identifying new and correcting missing or incorrect coverage used by your MMIS.

• Obtain coverage leads directly from insurance payers for accurate and timely coverage.
• Utilize advanced data mining activities to uncover hidden coverage opportunities, ensuring that every possible avenue is explored to maximize cost avoidance for your organization. 
• Streamline the coordination of benefits for Medicaid beneficiaries through quick and accurate coverage matching in your MMIS. 
• Reduce the time and effort required to manually verify coverage information and minimize rejections due to incorrect data.
• Ensure Medicaid beneficiaries receive the care they need with better coverage quality in your MMIS.

COVERAGE LEAD IDENTIFICATION 

Bulk up your cost avoidance efforts and reduce access to care issues for beneficiaries by identifying new and correcting missing or incorrect coverage used by your MMIS.

• Obtain coverage leads directly from insurance payers for accurate and timely coverage.
• Utilize advanced data mining activities to uncover hidden coverage opportunities, ensuring that every possible avenue is explored to maximize cost avoidance for your organization. 
• Streamline the coordination of benefits for Medicaid beneficiaries through quick and accurate coverage matching in your MMIS. 
• Reduce the time and effort required to manually verify coverage information and minimize rejections due to incorrect data.
• Ensure Medicaid beneficiaries receive the care they need with better coverage quality in your MMIS.

PUBLIC PORTAL FOR COVERAGE SUBMISSION 

Put your running shoes away, the chase for information is over. Our online public portal is an advanced data capture system that allows stakeholders, both internal and external, to seamlessly provide coverage information.

• Simplify the collection process by allowing beneficiaries, providers, and other external sources to submit coverage leads and updates through a secure user-friendly portal. 
• Assign priority to urgent leads ensuring timely and accurate handling through automated workflows. 
• Enable prompt verification of leads with streamlined workflows to significantly reduce the need for time-consuming manual verification efforts. 
• Improve your coverage quality and accuracy by automatically adding approved submissions directly to your MMIS in real time. 
• Assist in identifying trends in missing coverage, ultimately improving the quality and accuracy of your coverage data. 

CLAIM IDENTIFICATION & BILLING SUPPORT 

Add transparency where it is needed, with the option for state–specific customizations to meet your unique billing preferences and needs.

• Efficiently identify and track claims that may be eligible for third party reimbursement.
• Interface directly with the MMIS to manage the disallowance process to ensure integrated claim takebacks while managing provider abrasion.
• Improve billing efficiency and third party providers’ compliance with Medicaid regulations.
• Lighten the daily workload by automatically identifying claims and generating HIPAA-compliant EDI billing files, including X12 and NCPDP files.

CLAIM IDENTIFICATION & BILLING SUPPORT 

Add transparency where it is needed, with the option for state–specific customizations to meet your unique billing preferences and needs.

• Efficiently identify and track claims that may be eligible for third party reimbursement.
• Interface directly with the MMIS to manage the disallowance process to ensure integrated claim takebacks while managing provider abrasion.
• Improve billing efficiency and third party providers’ compliance with Medicaid regulations.
• Lighten the daily workload by automatically identifying claims and generating HIPAA-compliant EDI billing files, including X12 and NCPDP files.

CLAIM ACCOUNTING RECONCILIATION OF PAYER REMITTANCES 

Put more money back into Medicaid by easily identifying missing or incorrect payments through reconciling checks received from payers with the EDI response files. 

• Transparent claim lifecycle tracking of the repayment process down to the line-level. 
• Lighten the administrative burden on both your staff and payers by simplifying the remittance process and reducing the need for manual paperwork. 
• Ensure timely and accurate payment reconciliation with a centralized platform for tracking payments. 
• Customize account coding to ensure funding is appropriately returned to maximize recoveries. 

MANAGEMENT OVERSIGHT TOOLS

Our solution provides complete transparency to understand what’s going on beyond just the numbers. Easily monitor the automated billing and response process to stay informed in real-time and track key statistics with custom dashboards created to oversee coverage changes.

• Keep TPL leadership, your team, and vendors informed by visually communicating key information that can be used to troubleshoot or inform data-driven decision-making.
• Proactively identify patterns and issues with access to real-time data and address issues in automated processes.
• Optimize your auditing process with an end-to-end billing process oversight dashboard.
• Increase transparency and communication with easily generated reports and graphs around your coverage data.
• Track significant changes, trends, and patterns all in one place with user-friendly oversight dashboards.