Coordination of Benefits (COB) Solution
Streamline coordination of benefits to help reduce avoidable costs, improve payment accuracy, and create a better experience for members and healthcare partners.
Improve payment accuracy with smarter coordination of benefits
When coverage information is incomplete or outdated, health plans can face unnecessary costs, administrative burden, and member abrasion. Carelon combines data, analytics, operational expertise, and thoughtful member engagement to help identify, verify, and update other coverage information. This connected approach helps health plans improve claims payment accuracy and strengthen cost containment.
Lines of business:
- Commercial
- Medicare
- Medicaid
- Federal employee
Audience:
- Payers
Build a more proactive approach to cost containment
Effective coordination of benefits depends on having accurate coverage information at the right time. Carelon helps health plans identify other coverage earlier, support more accurate payment decisions, and keep member coverage information current through a smarter, more connected approach to COB.
Identify other coverage sooner
Use data-driven discovery and validation strategies to help uncover potential coverage before avoidable claims costs occur.
Improve accuracy without increasing abrasion
Support more accurate payment decisions while using focused member engagement to help reduce confusion, rework, and unnecessary outreach.
Keep coverage information current
Help maintain more accurate member records over time with ongoing monitoring, verification, and update processes that support long-term savings.
Connect coverage insights to more accurate payment decisions
Carelon helps health plans improve coordination of benefits through connected capabilities — from targeted data mining to performance measurement.
Multi-source coverage discovery
Analyze internal plan data, third-party data sources, claims patterns, and member-level indicators to identify potential other insurance coverage.
Member and carrier verification
Confirm active coverage through structured outreach, direct carrier validation, and documentation workflows designed to reduce uncertainty.
Claims-level COB review
Review claims impacted by other coverage to help determine payment responsibility, support accurate processing, and reduce avoidable overpayments.
Records updates and maintenance
Update member eligibility and coverage records so verified COB information can support downstream claims processing and future cost avoidance.
Operational reporting and savings visibility
Track identified coverage, verification activity, claims impact, recoveries, and cost avoidance with reporting that helps measure COB performance.
Experience that delivers measurable value
Carelon brings scale, expertise, and a strong track record of helping health plans improve payment accuracy and reduce avoidable costs.1
How the solution works
Find potential other coverage
We analyze plan data, third-party data sources, eligibility information, claims patterns, and member-level indicators to identify members who may have additional health insurance coverage.
Verify coverage details
We validate other coverage through member and carrier outreach, structured documentation workflows, and available eligibility data.
Determine primacy
We use rules-based logic and COB expertise to help determine whether another payer may be primary, secondary, or responsible for a share of the payment.
Update records and support claims accuracy
We document and share validated COB information to help health plans update member records and support accurate claims processing.
Measure and improve performance
We provide visibility into verified coverage, claims impact, recoveries, cost avoidance, and opportunities to help improve ongoing program performance through reporting and dashboards.
Explore a better COB approach
See how Carelon can help you identify other coverage earlier, reduce avoidable costs, and strengthen claims accuracy.
Frequently asked questions about coordination of benefits
1 Internal Carelon data, 2025.