Coordination of Benefits and Patient Involvement Denials

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Up to 70% of COB and PI denials are recoverable – if you have the right partner.

Payers increasingly require information from patients to process claims, adding complexity to and delaying resolution timelines. We work between patients and payers to resolve complex denials, recover revenue, and advocate for your patients to get the coverage they deserve.

Our expert-led solution, supported by proprietary AI and machine learning, manages the full resolution process for claims requiring patient involvement and payer coordination,-including, but not limited to, COB and PI denials. We advocate for your patients to convert denied or stalled claims into payments.



See the results that matter:

  • 70%+ average overturn rate with payers
  • 30-40% lift over current recovery efforts
  • 40% faster time to payment

CASE STUDY

Learn how Knowtion helped one children’s hospital coordinate benefits for families.

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The Challenge

At one 450+ bed hospital and Level 1 Pediatric Trauma Center, an insurer was delaying payment on an MRI claim for a foreign body causing pain in a child patient’s nose. The providers needed payment, and the child’s parents were eager to resolve the issues and avoid unexpected bills.

The Solution

Approach

  1. Our expert team determined that the insurer needed to know whether the child’s condition was related to a motor vehicle accident before paying the claim, as that would require payment from auto insurance coverage.

  2. A Knowtion representative contacted the patient’s parent to explain the delays and gather the needed information.

  3. Knowtion facilitated a three-way call with the parent and the insurer, and the parent explained there was no third-party liability involved.

  4. Knowtion requested that the claim be sent back for processing.
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Result

When experts in denials management come together—from billing and coding specialists to clinicians to attorneys—the results can be powerful. With canned appeals, providers frequently overturn less than 30% of clinical denials. Using Knowtion Health’s dedicated team and customized appeals process, those rates increase to 65% or more.

Why leading health systems choose Knowtion Health

Our resolution approach is specific to COB and PI denials, not part of a broad RCM workflow. We combine payer industry, medical, and legal expertise with AI and machine learning to exceed current COB and PI resolution rates by up to 40% across any hospital-based billing system.

 

Discover the Knowtion difference.

Discover the Knowtion difference.

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Ready to unlock more revenue while protecting your patients?

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