Project Overview
SOV’s Member and Provider Services (MPS) department, in collaboration with Gainwell, has implemented Payer Initiated Eligibility (PIE) to meet federal mandates. While PIE has successfully automated updates for Blue Cross Blue Shield of Vermont, integration challenges with United Healthcare and Cigna hinder its full capabilities.
To enhance Medicaid as the payor of last resort, National Eligibility Data Base (NEDB) Project is investigating a COB On-Demand solution with Gainwell. This four-month project will analyze current processes, assess technical requirements, and develop an implementation plan. The anticipated operation monthly cost is $8,366, with additional fees for population verification.
By adopting COB On-Demand, NEDB expects to optimize workflow, improve third-party coverage identification, and ensure accurate Medicaid processing.
Key Contacts
- Suellen Bottiggi – Project Sponsor (PS)
- Victoria Marcotte – Business Lead (BL)
- Serena Kemp – Portfolio Manager (PfM)
- Mike Ryal – Project Manager (PM)
- Pat Farrell – OCM Lead (OCM)