COB

AuditShark COB

Automated First Pass COB

Every LOB. Every Lead Source. Every Time.

Discover new cob savings today
AS-COB-banner-icon
path

THE PROBLEM

Payers are leaving millions on the table each year by missing cost avoidance, overlooking recoveries, and paying steep contingency fees to vendors. Coordination of Benefits (COB) operations depend on data, but raw COB data is like crude oil—it’s only valuable once refined. Lacking the tools to efficiently process it, payers struggle with manual validation, brute force approaches, costly vendor fees, and are unable to fully optimize payment accuracy or maximize recoveries.

GO DEEPER

The Opportunity:10-14% of health plan members have other insurance, but the data is often outdated, inaccurate, or inaccessible due to disconnected systems of record – leading to enormous volumes of rework and missed savings

Overreliance on Post-Pay Recoveries: Health plans want to increase Coordination of Benefits (COB) cost avoidance but lack verified other party liability data at the point of adjudication, creating a dependence on post-pay recoveries

Inefficient Process: COB teams may handle the same member across multiple systems (e.g., MSP/Section 111, Call Center, EOBs), or by line of business, creating inefficiencies and missed savings

Many health plans still use phone calls, member surveys, and manual reviews to verify coverage on each lead source, limiting productivity with legacy workflows

Lack of Automation & Analytics:Without advanced tools, internal teams struggle to prioritize the right leads, wasting time on low-value leads while the backlog piles higher and higher

Expensive External Vendors: Health plans have grown their reliance on external vendors with high contingency fees, increasing the costs of recovering those dollars

go-deeper

CHALLENGES BY LINES OF BUSINESS

CMS is often forced to rely on bad coverage data from commercial plans, leading to Garbage In Garbage Out problems downstream. They often over-estimate MSP rates. This leads to reduced MA premiums, and claims paid at commercial rates. Leverage AuditShark COB to reduce MSP rates, maximize MA premiums, and reconcile months of missed premiums.

As the payer of last resort, Medicaid plans suffer the most from bad COB data. State Medicaid Departments issue notoriously low accuracy TPL files, which are often the only lead source available for MCOs and Medicaid plans. Medicaid plans gain the most from a modern Coordination of Benefits (COB) operation.

Coverage dependence changes frequently and is often difficult to verify, usually requiring time-consuming phone calls for confirmation. Each state can have different rules and regulations regarding how Coordination of Benefits (COB) can be used and when, which can make it hard to scale across stateliness.

OUR SOLUTION

AuditShark COB is the first and only platform to offer a fully automated, end-to-end approach to Coordination of Benefits. Purpose-built for health plans, our platform enables internal teams to maximize efficiency, increase hit rates, drastically boost cost avoidance while reducing the cost of recovery.

Get the MOST out of your COB team.

SOLUTION FEATURES

  • Global TPL Data Management
    Access EVERY Lead Source and then leverage them in order of quality, accuracy and cost
  • Automatic Verification of Every Lead Source
    Hang up the phone and let AuditShark do the verification for you
  • Maximum Cost Avoidance
    Pay claims right the first time with the most up to date, accurate, verified, OHI and COB information at the point of adjudication
  • Automated Recoveries and Adjustments
    Analyze and Verify Overpayments, initiate letters, and make adjustments all with an automated platform
  • Prioritized Work Queues
    Experience a 100% hit rate on recoveries and rank work queues in order of financial impact
  • Detailed Reporting and Insights
    Easily track and report ROI, lead source accuracy, per user efficiency and over 120 other KPIs
solution-features
CAQH

Get the MOST out of your CAQH Data.

We believe you shouldn’t have to work hard to get value from your COB data sources.
Instead, those data sources should work for you!

AuditShark COB is pre-integrated with the CAQH COBSmart data file, which delivers a seamless, end-to-end solution for the entire COB life cycle and for all CAQH customers and users. Maximize the value of all of your COB Data sources and let AuditShark scrub, analyze, verify, and automate COB leads. Streamline the entire lead generation process and automate recovery efforts for unmatched efficiency and maximum ROI. Easily track, measure and report ROI.

SOLUTION BENEFITS

  • check_mark
  • Maximum Automation and Efficiency:

    Eliminate legacy administrative workflows and reduce administrative costs

  • check_mark
  • Clear and Demonstrable Return on Investment (ROI):

    Track and measure every aspect of the COB process to ensure value at every step

  • check_mark
  • Maximum Cost Avoidance and Savings:

    Ensure payment accuracy, reduce rework, and increase total COB savings

  • check_mark
  • Enhanced Compliance:

    Easily pass COB Audits and Ensure Payment Accuracy and Timely Recoveries

With AuditShark COB

Health Plans can experience

  • cost-avoidance

  • Maximum

    Cost Avoidance
  • recovery

  • Effortless

    Recovery

Schedule time with our team to get started on
your COB Transformation journey today!

Contact uscontact