DataSpring Coordination of Benefits Case Study

This case study outlines the partnership between a mid-sized Medicare Advantage (MA) plan and DataSpring, formerly known as CAQH, to address revenue loss due to inaccurate Medicare Secondary Payer (MSP) designations. The MA plan faced significant underpayments, with monthly capitation payments reduced by up to 70% for certain members. The study details how DataSpring implemented a data-driven strategy to identify and rectify these discrepancies, utilizing eligibility information for over 225 million covered lives. This approach led to the recovery of $10 million in retrospective revenue and $5 million in prospective revenue adjustments within a year. The case study emphasizes the importance of accurate COB data in improving financial outcomes and operational efficiency, highlighting the successful resolution of a multi-year backlog of underpayments. By enhancing data integrity and ensuring correct financial responsibility, the partnership ultimately benefited both the health plan and its members.