Optimize Your Revenue Recovery Potential
Healthcare is challenging enough — as are the nuances of Medicare. Adding secondary payers into the mix adds more complexity for health plans that are already wrangling with evolving regulatory and compliance measures, time-sensitive mandates, and staffing and technology challenges. Until now.
Real-time data synchronization for Medicare Secondary Payer (MSP) by Imagenet—powered by CodySoft®—ensures your plan makes required payments only when it needs to make them, reducing Medicare expenditures and complexities.
Core Capabilities:
- Identification and validation of capitation recovery opportunities
- De-duplication, record grouping, and tracking of electronic correspondence
- Automatic reconciliation of primacy flags within claims payment systems
Empowering Healthcare Payers in Multiple Ways:
Optimal Data Management
Automated & Improved Reconciliation
Ensured Payment Accuracy
Reduced Administrative Burden
Make Real-Time Benefits Reconciliation Easy
Coordination of Benefits (COB) rules determine how multiple health plans pay insurance claims for one shared member. But it often feels like payers’ "solutions" work against them. That’s where Imagenet’s Coordination of Benefits (COB) Module—powered by CodySoft®—comes in. Working independently, or seamlessly in tandem with our MSP module, our COB solution expertly manages CMS Part D coordination of benefits files.
Core Capabilities:
- Identification of new enrollees and annual records with customizable business rules
- Automatic and timely updates to downstream claim systems
- Proactive identification of overlaps and gaps
Your Revenue Recovery Potential
$700K
In premium recovery from CMS for a Medicare Advantage Organization (MAO) with approximately 32,000 members
$500K
Recovered for a small MAO with approximately 5,000 members
$400K+
Recovered for an MAO with approximately 15,000 members
“This easy-to-implement solution reduced administrative costs, improved timeliness standards, and reduced member communication errors.”
— Leading Not-for-Profit Healthcare System in the Southwest
Frequently Asked Questions
How does Imagenet improve Medicare Secondary Payer (MSP) accuracy?
Imagenet synchronizes MSP data in real time, validating capitation recovery opportunities, de‑duplicating records, grouping correspondence, and automatically reconciling primacy flags within claims systems. This ensures the plan only pays when required and reduces Medicare expenditures.
What administrative challenges do MSP and COB workflows typically create for health plans?
MSP and COB processes often involve complex rules, inconsistent data, manual reconciliation, and time‑sensitive mandates. These challenges increase administrative burden, risk overpayments, and create compliance exposure, issues Imagenet’s automated modules are designed to eliminate.
How does Imagenet’s Coordination of Benefits (COB) Module work?
The COB Module manages CMS Part D coordination of benefits files, identifies new enrollees and annual records, applies customizable business rules, updates downstream systems automatically, and proactively flags overlaps or gaps in coverage.
What measurable financial impact can Imagenet’s MSP and COB solutions deliver?
Imagenet’s clients have recovered hundreds of thousands of dollars in premium revenue, including $700K for a 32,000‑member MAO, $500K for a 5,000‑member MAO, and more than $400K for a 15,000‑member MAO, demonstrating strong revenue recovery potential.
How do these solutions reduce administrative burden for health plans?
By automating reconciliation, validating coverage, synchronizing data, and reducing manual review, Imagenet minimizes rework, improves timeliness, and decreases member communication errors, resulting in smoother operations and stronger compliance.