A regional health plan with 3.5 million members struggled to fully use CAQH COB Smart data, leaving $5 million in annual recoveries unclaimed due to challenges in validating members’ overlapping coverage, especially during Medicare transitions. Conduent applied advanced data-matching tools, validated 85 percent of undetermined and 15 percent of determined CAQH records, and created customized recovery processes. This approach uncovered previously hidden coverage, re-billed appropriate payers, and minimized member disruption. Since 2018, Conduent has helped the plan recover $9 million in missed payments and is generating an additional $5 million annually in recoveries.

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