In a Health Leaders webinar–From Delay to Pay: Solving Denials Disruptions, Patient Info Gaps and COB Issues in the Revenue Cycle–sponsored by Knowtion Health, these top revenue cycle leaders shared their experiences and strategies for navigating Coordination of Benefits (COB) and patient involvement denial challenges head-on. 
Mikky Franklin Addresses Audience Q&A below:
Q1. Has anyone attempted to create a system wide patient coverage attestation form? Can it be used in appeals?
Answer: Yes. Several organizations use standardized attestation forms at registration to confirm that the patient has disclosed all active coverage. While not a substitute for payer records, these forms can strengthen appeals by showing the hospital took reasonable steps to verify coverage directly with the patient at the point of service.
That said, patient self-reporting is imperfect–many forget about secondary coverage or provide outdated plan details. Teams that succeed here don't just file the attestation with the claim. They:
- Pair attestations with electronic insurance discovery tools to confirm coverage across clearinghouses and payer databases.
- Index the attestation into the claim file so it's immediately retrievable in appeals.
- Use attestation data in denial root-cause trending, comparing where patients miss coverage versus where eligibility tools identify it.
The form works best when it's part of the closed-loop process that validates, documents, and feeds back into payer escalation strategies.
Q2. Why do some healthcare providers have a harder time managing COB and patient involvement denials than others?
Answer: Variation often comes down to follow-through after the patient provides information. Many organizations capture data well on the front end but fail to integrate it into:
- Timely rebilling workflows (ensuring the COB update triggers a corrected claim submission within filing limits.)
- Denial ownership models where one team follows a claim from initial denial through resolution.
- Feedback loops to registration and scheduling so recurring error are addressed upstream.
Hospitals that struggle often silo responsibilities–front-end teams collect information, but back-end teams lack visibility and sufficient follow-up resources, leading to missed deadlines and higher write-offs.
Q3. What is the most common mistake once a patient provides missing coverage information?
Answer: The biggest gap is failing to track the claim through to actual reprocessing and payment. Many revenue cycle teams assume that once the patient supplies missing information, the insurer will automatically reprocess. In reality, claims frequently remain in limbo.
Successful back-end strategies include:
- Active follow-up protocols (automated ticklers/work queues to check claim status 15-20 days after resubmission).
- Direct payer outreach to confirm COB updates were applied and a corrected claim was generated.
- Audit logs that record when/where the patient supplied coverage so appeals can demonstrate compliance if reprocessing is delayed.
A well-timed payer call often serves as the trigger that actually moves the claim to payment.
Q4. What is the recommendation when COB processes are strong but denials persist?
Answer: When front-end COB capture is solid yet denials continue, it usually signals payer-driven delays or system mismatches. Next-level strategies include:
- Documenting compliance: Ensure a full audit trail of attestations, eligibility results, and call logs.
- Denial escalation playbooks: Track repeat offenders, apply prompt-pay statutes, and escalate to managed care/legal.
- Payer report cards: Quantify denial frequency and aging by payer, then use this data in contract negotiations.
This turns COB from a one-off denial management issue into a strategic managed care lever. Partnering can be a successful way for hospitals to enhance their tracking and reporting capabilities in these areas.
Q5. Should your organization have a payer escalation team to handle bad payer behavior?
Answer: Most organizations don't stand up a standalone team, but high-performing systems operate under a structured escalation framework:
- Tier 1: Business office staff document and work first level denials.
- Tier 2: Complex or repeat issues route to a designated escalation group with payer-specific playbooks.
- Tier 3: Managed care/legal engage with contract leverage, regulatory complaints, or DOI filings.
The key isn't creating a separate team–it's ensuring ownership is clear, documentation is airtight, and repeat issues are systematically escalated.
Q6. Will Epic solve COB and patient involvement denials?
Answer: Epic (and other core systems) can flag missing data and push real-time eligibility checks, but they don't enforce payer compliance. Systems that reduce COB denials combine Epic with:
- Insurance discovery vendors that sweep for missed coverage
- Patient engagement tools (Self-service portals, text email outreach)
- Escalation workflows that document payer non-compliance
Think of Epic as the backbone, but success depends on layering in specialized discovery and denial management strategies.
Q7. Why are COB denials becoming a higher priority for hospitals?
Answer: COB denials are rising for three main reasons:
- Increased government scrutiny: CMS and RACs are aggressively enforcing MSP rules.
- Expansion of data-matching: Federal/state agencies now share eligibility data, creating more mismatches if hospital systems aren't aligned.
- Insurance churn & market shifts: Marketplace auto-enrollment, Medicaid policy changes, and potential ACA subsidy expirations create more dual-coverage scenarios and coverage lapses.
Operational implications for hospitals are a need for:
- Robust, audit-ready documentation for appeals.
- Real-time monitoring of Medicaid and ACA marketplace rules across states.
- Dedicated denials management workflows assuming COB denials will rise.
COB is no longer just a registration issue–it's a strategic revenue cycle risk requiring back-end rigor and payer accountability. A partner with strong information capture and tracking systems and expertise in COB and patient involvement denials can help tackle these challenges head-on.
Q8. How do motor vehicle accident (MVA) claims complicate COB, and what strategies work best?
Answer: MVA-related COB is difficult because once an accident is flagged in a payer's system, subsequent, unrelated claims may also be stopped. For example, a January accident visit may trigger a flag that blocks February's gallbladder claim, even if coding shows it is unrelated.
Best practices:
- Dedicated MFA denial queues handled by specialized teams
- Attestation forms tied to accident status for appeal support
- Escalation protocols to challenge systemic payer delays
Without clear rebuttals, payers can continue to suspend unrelated claims.
Q9. Beyond insurance discovery, how else can technology support COB and patient-involvement denials?
Answer: Leading organizations leverage automation and communication tech to improve speed and reduce touches. A strong partner can offer:
- Smart outreach platforms, with customized emails/texts linking patients to payer-specific portals.
- Auto-generated denial letters with templates that auto-populate details from notes to speed processes and improve accuracy.
- Time-saving cross claim auto-fill capabilities, where information captured once will flow to related claims.
- Workflow dashboards with real-time visibility into denial aging and payer response.
These tools cut manual touches and standardized payer-facing documentation–the difference between timely resolution and a drag on A/R.
Q10. What's the most overlooked opportunity to speed up COB resolution?
Answer: Integrated patient communication. Too often COB outreach is handled by mailed letters with slow turnaround. Multichannel outreach–texts, emails and portals with payer specific forms–creates faster patient responses and fewer missed deadlines.
When patients can upload accident questionnaires or COB attestations from their phone in real time, denial clocks shorten dramatically. Pair this with auto-populated form and structured payer workflows to turn weeks of back-and-forth into same day resolution.
Learn more by viewing this on-demand From Delay to Pay webinar.
About Knowtion Health
Knowtion Health is a leading provider of technology-enabled revenue cycle management services. The company leverages AI-driven technology and deep domain expertise to reduce denials and underpayments across all denial types, low balance accounts, and complex claims, while enhancing patient experience and satisfaction. Recognized as an Inc. 5000 fastest-growing company, Knowtion Health is a multi-year recipient of the Black Book award, which honors top partners as ranked by healthcare providers. To speak with an associate about your denials program, please contact us at Services@KnowtionHealth.com.
