Advanced Analytics Aim to Streamline Coordination of Benefits with Dan Gallagher Lyric

Empowered Patient Podcast

Dan Gallagher, Vice President for Strategy and Partnerships at Lyric, describes how Lyric uses advanced analytics to improve the coordination of benefits by proactively identifying coverage changes, verifying eligibility at the time of service, and transitioning patients to the correct payer. Coordination of benefits can be complex due to job changes, data lags, and situations like workplace accidents where multiple payers may be involved. Improving coordination of benefits can reduce patients' out-of-pocket costs and get providers paid faster.

Dan explains, "Simply stated, coordination of benefits is determining who or what entity has financial responsibility for an individual during a course of treatment. So, for a large portion of the population, it's pretty straightforward. You may have commercial insurance, and you may have one insurance card for your family, but there's not a lot to coordinate for other members of the population. You may have Medicare and you're still working over the age of 65. You may be under the age of 65 and have some conditions that make you Medicare eligible. You may have another spouse or two insured in the same family."

"Then there are always remnant issues like work comp. Maybe you got hurt at work, had a motor vehicle accident, or had a slip and fall where there's another party responsible for the medical bills. Coordination of benefits is the process of identifying all the parties that might have a responsibility and then putting those parties in the right order so that the member pays the correct amount if they owe anything and that all the other parties pay their fair share."

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