Case Study: a major health plan recovers $9M in missed COB savings with Conduent

Helping a major health plan leverage CAQH COB Smart files to recover millions through previously unidentified Coordination of Benefits opportunities

A major health plan company, a regional insurer with 3.5 million members, was struggling to identify and validate members' other health coverage from its CAQH COB Smart data. This challenge, particularly with members aging into Medicare, meant the company was missing out on an estimated $5 million in annual recoveries from overpayments. They lacked the expertise and resources to fully leverage and validate the high-volume data stream, leaving significant cost-avoidance savings opportunities untapped.

Conduent implemented a customized solution to maximize the value of the health plan's CAQH membership. Their team validated a large portion of the undetermined and determined records, used proprietary data analytics and multiple data sources to identify other coverage, and employed a low-touch engagement model to minimize member outreach. As a result, Conduent helped the plan recover $9 million in previously missed payments since 2018 and an estimated $5 million in 2021 alone.