New vendor for post-payment claim and COB reviews
Apr 18, 2024
Starting in June, we’ll be working with The Rawlings Group, a payment integrity services vendor, to help identify claim overpayments related to coordination of benefits (COB). The focus will be on post-payment claim reviews and recovery, as well as COB updates. If an overpayment is identified, Rawlings will help the member understand the coordination of their benefits and contact the provider directly for payment recovery.
This oversight is an industry-standard practice and will apply to all Dean Health Plan and Prevea360 Health Plan products and include all medical claims, except Administrative Services Only (ASO) plans. Worker’s compensation and subrogation claims aren’t in scope.
The Rawlings Group is a trusted business associate — as defined by the Health Insurance Portability and Accountability Act (HIPAA) — which allows the sharing of protected health information for specific purposes such as inquiring about other health insurance coverage.