Coordinate
Determine who pays with scalable AI and human precision.
Mastering Coordination of Benefits (COB) requires both expertise and advanced technology. While machines sift through huge volumes of data to look for potential overlaps and assess the likelihood of a problem, our seasoned professionals guide the work and drive payment accuracy, speed, and confidence.
Metrics that matter.
93%+
average recovery rate across all lines of business, including Medicare, Medicaid, and Commercial
>$1B
in recoveries and cost avoidance annually
30+
years of COB expertise trusted by leading payers nationwide
We get it
Payers lose billions every year to COB errors.
When members have multiple plans, misalignment between payers leads to overpayments, compliance risk, and administrative waste. Existing COB solutions often rely on outdated data, static rules, or manual investigation. Every inaccurate decision results in downstream claim rework, provider recovery efforts, and increased spend.
Most vendors chase recoveries. We prevent overpayments before they happen.
WHAT WE DO
The system behind smarter COB.
Machinify combines enriched data, configurable rules, and credentialed subject matter experts to identify primary coverage, prevent overpayments, and recover what others miss. Whether you act before the claim or after the check, the process is clear and proven.
Pre-claim
Pre-claim
- Ingest and Enrich Data
We resolve the hidden complexities of COB with advanced analytics and enrichment techniques. Predictive models proactively detect overlapping or unreported coverage through real-world indicators like employment changes, Medicare enrollment, or dual plan participation. - Apply the Workflow
Our AI operating system runs payer-specific COB logic to determine primary coverage for each flagged member. Cases are prioritized by risk score and enhanced with additional facts prior to distribution to our subject matter expert review teams. - Resolve and Document
Subject matter experts verify decisions before action is taken, driving accurate primacy determinations. Clients can apply real-time file updates through integration or handle adjustments internally. All determinations are logged for audit, compliance, and downstream reporting. - Learn and Optimize
Our system continuously refines its logic based on performance, driving more accurate identifications and greater cost avoidance. Tailored insights for each payer minimizes leakage and steadily improves efficiency.
Pre-pay
Pre-pay
- Ingest and Enrich Data
Our Pre-Pay solution evaluates real-time claims in conjunction with eligibility records, plan contracts, and policy rules. We continuously update data from authoritative sources, such as CMS and CAQH, to ensure decisions are based on the most current coverage information. - Apply the Workflow
We apply NAIC rules, state and federal guidelines, and your plan’s contract language to determine whether you are the responsible payer before the claim is paid. Claims with conflicting or incomplete information are flagged and routed to subject matter experts for fast, defensible resolution. - Resolve and Document
Flagged claims are reviewed by credentialed subject matter experts using payer-configured workflows. Once validated, records can be updated in real time, or the claim can be routed for manual resolution. All determinations are documented with audit-ready clarity. - Learn and Optimize
The platform tracks claim-level outcomes to improve targeting and reduce exception volume. Over time, your pre-pay accuracy increases and your need for post-pay recovery decreases.
Post-pay
Post-pay
- Ingest and Enrich Data
Our platform analyzes previously adjudicated claims, payment history, plan rules, and enriched eligibility data to identify claims where your plan was not the primary payer. Life event data and plan overlaps help us surface missed COB opportunities, even months after the original payment. - Apply the Right Workflow
Once an overpayment is identified, we launch recovery workflows tailored to the scenario, whether it requires outreach to providers or other payers. Our subject matter experts apply payer-specific COB logic and provide documentation to support any recovery or reprocessing effort. - Resolve and Document
Cases are reviewed and confirmed by our subject matter experts, to provide recoveries that are accurate and defensible. Whether the solution involves claim retraction, provider rebilling, or member outreach, we provide a complete audit trail and all supporting artifacts. - Learn and Optimize
Machinify's post-pay results don't just resolve errors, they power prevention. Recovery trends, denial rates, and exception patterns are fed back into the system to strengthen pre-pay and pre-claim logic, creating a smarter, more resilient process with every cycle.
THE MACHINIFY DIFFERENCE
We deliver what others miss at scale.
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Signal detection
Real-time discovery of coverage overlaps across complex data sets.
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Predictive matching
Flags unreported coverage before claims are filed.
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Human oversight
Exception handling by credentialed subject matter experts to drive accuracy and quality outcomes.
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Audit-ready evidence
Full documentation trail for compliance, reporting, and recovery support.
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Operational flexibility
Supports pre-claim, pre-pay, and post-pay workflows tailored to payer needs.
Our Perspective
Real insights from our COB leadership.
COB isn’t just clerical. It’s strategic, and with Machinify, it’s finally intelligent. Senior Vice President of COB, Gary Woodward, shares a deeper look at our COB solutions in this article.
Human expertise where it matters most.
Behind every automation is a team of credentialed subject matter experts focused on accuracy, compliance, and clarity. Our COB experts understand the nuances of life events, enrollment transitions, and eligibility rules, handling the complex situations that require human judgment and expertise.