Premera Blue Cross Coordination of Benefits Case Study

This case study details how Premera Blue Cross implemented a new system for identifying overlapping coverage to enhance the member experience while reducing costs. Previously, Premera relied on a manual process of sending letters to members to obtain Coordination of Benefits (COB) information, which was both expensive and yielded a low response rate. The organization sought a more efficient solution that would minimize member and provider involvement. They adopted the CAQH Coordination of Benefits solution, which utilizes a national registry to identify members with overlapping coverage and determine primacy. This approach allows Premera to handle COB issues more discreetly and efficiently. As a result, Premera has reported a 27 percent increase in recoveries and a 21 percent rise in overpayment identifications. The implementation of this solution has not only improved the accuracy of claims processing but also reduced operational costs significantly, allowing Premera to reallocate resources effectively.