Coordination of Benefits

With approximately 1% of medical spend and millions of dollars of overpayment associated with COB, technology and automation can have a positive impact on your internal audit team’s efficiency and COB overpayment findings. A Payers internal COB team spends a lot of time on administrative and manual processes. With an integrated platform and automation, your team can turbo charge internal COB findings and move more to Cost Avoidance

AuditShark|COB is a Coordination of benefits platform purpose built to help Payers automate the process of finding members with other insurance coverage. AuditShark|COB eliminates the need for managing source files like State TPL, CAQH COB Smart etc., manually identifying Members, manually assigning work, logging into other insurance websites, and identifying potential overpaid claims. AuditShark|COB can bring together all your files including your back sweep/Members with enrollment changes, state TPL, CobSmart (CAQH), MSP Section 111 files, identify the members with potential other insurance coverage, programmatically capture other payer coverage information (from their websites and IVR lines) and identify the Members with overpaid claims and changes in coverage and present them to your team for review.


Compliance: The application helps Payer be compliant with state and federal mandates
Higher COB findings: The AuditShark|COB application can double your internal COB findings. Rather than working on Members that have no coverage changes, prioritize your team to work on Members with changes and with overpaid claims. The application helps your allocate work intelligently to maximize overpayment findings
Proactive cost avoidance: Identify Members with other insurance coverage and move to pre-pay
Higher Productivity: Same team with 4X current productivity
Automation: Automate all manual tasks including file management, checking other insurance coverage, exclusions like non-covered services etc.


Workflow – Customizable workflow to match your current setup
Rules – Configurable rules engine to help with maximizing productivity
Quality – configure peer review and validation
Data Aggregation – eliminate the need to log into other insurance websites. Automate the process of getting other insurance information
Artificial Intelligence, Machine Learning & Analytics – maximize savings