Problem Statement

A health plan should pay only when it's the responsible payer, which means keeping each member's other-coverage information current. Today secondary-insurance inquiries go out reactively, only once a member is already being investigated, rather than proactively, so coverage gaps go undetected and the plan risks paying as primary when it shouldn't. Sending these inquiries by hand wouldn't scale to the full membership.

Automation Solution

This automation proactively triggers a secondary-insurance inquiry letter in Facets for all members who have not received an inquiry in the past 365 days, supporting GOLD regulatory compliance.