Cotiviti Introduces AI-Enabled Proactive COB To Resolve Coordination of Benefits Issues at Enrollment

New capability validates other health insurance and determines benefit primacy before claims are submitted, preventing avoidable payment errors at their source

SALT LAKE CITY--(BUSINESS WIRE)--Cotiviti, The Healthcare Infrastructure Company™, has launched Proactive COB, a new coordination of benefits (COB) capability that identifies other health insurance (OHI) and determines the correct order of benefits at the time of member enrollment—before claims are submitted. Enabled through enrollment and maintenance transactions processed via Cotiviti’s standards-native gateway, Proactive COB extends intervention upstream, applying AI to interpret complex coverage signals and prioritize potential discrepancies early enough for health plans to prevent inaccurate payments before they occur.

“Coordination of benefits has long been treated as a downstream payment issue, when the underlying problem begins much earlier with incomplete or outdated coverage information,” said Naomi Murphy, J.D., Executive Vice President of Data Mining and COB for Cotiviti. “When payers don’t have timely visibility into other health insurance coverage, incorrect order of benefit determinations are frequently not discovered until claims have already been paid. By combining AI-enabled analysis with one of the industry's largest validated member datasets and decades of COB expertise, Proactive COB advances Cotiviti's mission to become the structural utility layer connecting American healthcare—resolving the information asymmetry between payers and providers.”

COB errors often begin when member coverage changes due to life events such as employment changes, changes to family dynamics, or other circumstances that can alter payment responsibility. Because many health plans do not receive complete, accurate, or up to date coverage information, these issues frequently remain undetected until after claims have been paid, creating costly recovery efforts, administrative burden, and provider rework. Traditional approaches typically rely on retrospective discovery methods that can leave a significant portion of identified overpayments unrecovered.

Proactive COB addresses this challenge by identifying and validating OHI, determining the appropriate order in which benefits should be paid, and automatically updating eligibility systems with validated information. The solution combines embedded AI-driven prioritization, one of the industry’s largest validated member databases, and more than 25 years of COB experience to help plans maintain more accurate member coverage records throughout the benefit lifecycle.

“Even when health plans have access to current coverage information, they have still historically lacked a reliable mechanism to continuously validate that data between enrollment and claims processing,” continued Murphy. “As a result, they’re often forced into a reactive cycle of identifying errors after claims have been paid, recovering overpayments, and managing the downstream administrative friction that follows. Proactive COB shifts the focus from recovery to prevention, enabling plans to act on coverage changes as they happen and maintain more accurate primacy information throughout the member lifecycle.”

Unlike traditional COB programs that depend primarily on claim activity or member outreach, Proactive COB operates on member enrollment data, enabling health plans to identify and address coverage discrepancies even for members who have not yet generated claims. The capability also supports automated updates of validated OHI and primacy data to major eligibility and member management platforms, reducing manual intervention while maintaining a complete audit trail.

By embedding AI and human expertise within Cotiviti’s connected enrollment, validation, and eligibility workflows, Proactive COB moves intelligence to the earliest point in the COB lifecycle, helping health plans establish a more comprehensive and connected approach to payment accuracy. The solution is designed to reduce administrative waste, improve accuracy, and support more predictable cost avoidance by preventing errors before claims are generated.

About Cotiviti

Cotiviti’s infrastructure platform enables healthcare organizations to deliver better care at lower cost through advanced technology and data analytics that improve the quality and sustainability of healthcare in the United States. Cotiviti’s solutions increase transparency and collaboration between payers and providers while empowering them to reduce medical and administrative costs, enable better health, improve claims payment efficiency, streamline operations, drive interoperability, and advance value-based care. Its customers serve the majority of U.S. healthcare consumers, providing coverage and care for over 300 million members and patients. For more information, visit www.cotiviti.com.