Healthcare Payer Services

Coordination of Benefits

Section 111, MSP Validation, Duplicate Payment Identification, Retro-terminations, Workers' Compensation Offset

We provide supplemental Coordination of Benefits (COB), helping your internal COB efforts identify and recover benefits paid where Medicare or another healthcare payer should have paid primary. We share this updated Coordination of Benefits information with all stakeholders, so processes can be corrected and accurate payments can be made in the future.

Prepayment Investigation

The majority of overpaid claims are due to incomplete/incorrect information regarding a member’s work status. Don’t wait until claims are overpaid to accurately determine order of benefits.

Prepayment Investigation provides regular work status checks of all known Medicare entitled members, which allows you to know with confidence at the time of payment, the correct order of benefits.

Accurate Reporting

The new challenge for health plans reporting entitlement information to Medicare is to look beyond basic Section 111 compliance. With the right focus, the Centers for Medicare and Medicaid Services required data sharing can be a powerful tool.

By providing entitlement data, you reduce Medicare's potential for overpayment while increasing your risk. Let Recovery Services use our expertise to ensure that you are getting the most out of Section 111 mandated reporting.

  • Timely and accurate primacy determinations
  • Updates to the Common Working File
  • Maintenance of primacy records in your eligibility system
  • Accurate MSP and Non-MSP Reporting
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