Recovery of COB overpayments requires a deep knowledge of the statutes and regulations affecting claims payment transactions and laws vary greatly from state to state. Because The Rawlings Group provides recovery services in every state, our COB legal team developed this comprehensive reference guide to consult when reviewing claim investigations. We have been refining this reference guide over the last decade to address challenges facing our insurance clients as the industry continues to adjust to increased regulatory and statutory activity.

Each state’s insurance statutes and regulations contained herein are consistently monitored, researched and updated. This reference manual will aid in the management, administration and recovery of coordination of benefits claims. It can be used by the Law Department and COB divisions of Health Insurance Carriers, as well as third-party administrators (TPAs).

Click here to contact us regarding purchase of The National Coordination of Benefits Law Manual.

Proper Coordination of Benefits (“COB”) requires a deep knowledge of the statutes and regulations affecting claims payment transactions and laws vary greatly from state to state. Because The Rawlings Group provides identification and recovery services in every state, our COB legal team developed this comprehensive reference guide for use by our expert Payment Integrity analysts.

Each state’s insurance statutes and regulations contained herein are consistently monitored, researched and updated. This reference manual will aid in the management, administration and recovery of coordination of benefits claims. It can be used by the Law Department and COB divisions of Health Insurance Carriers, as well as third-party administrators (TPAs).

We work hard. We play hard. We strive for a culture of mutual courtesy and respect in our workplace relationships. We provide exceptional quality and superlative customer service in our partnerships with our clients. We emphasize professionalism and empathy in our contact with members, providers and everyone else we encounter. The Golden Rule is our company guidepost.

Now our company has been recognized by Forbes Magazine as one of America’s Best Mid-size Employers for 2018. The ranking was based on surveys of 30,000 Americans working for employers with more than 1000 employees. Rawlings ranked 244th on the list in the mid-size employer category which includes companies with 1,000 to 5,000 employees.

As a company, we have focused on improving our corporate culture and employee satisfaction by enhancing our already generous compensation packages. We have expanded our tuition reimbursement program because we believe in investing in our employees’ futures. We have started leadership education classes because we want to provide a path for career growth and opportunity to our staff. And we offer a full range of benefits to protect our employees’ and their family’s health and well-being. All of these efforts are aimed at improving our company as a workplace because we know our employees are the basis of our continued position as the industry leader.

As Mr. Rawlings reflected, “I would say that there is not a single day that goes by that I do not think about the well-being of our staff and my responsibility for their continued employment and how to create a place for them to have a successful career.” This philosophy is woven into the fabric of our company. Working together, we have succeeded in creating a special workplace. Congratulations, all, this recognition is truly a team effort!

Until the 1980s, it was rare for a health insurer to rely on subrogation and reimbursement as a significant cost savings application. However, identification of potential recovery cases has been dramatically improved through the use of systems detection methods such as the programs developed by The Rawlings Company LLC. These automated systems, combined with increased personal injury claims and economic factors, make subrogation and reimbursement necessary parts of any cost savings program. What was once a relatively dormant area of law has developed into a dynamic process in which the health plan must work to maintain its right to recover benefits when there is another source (such as a third party or other carrier) that has a primary obligation for paying those benefits.

 

This law manual can be used by the Law Department and Subrogation Divisions of Health Benefit Indemnity Companies, HMO’s, and PPO’s, as well as third-party administrators (TPAs) and law school libraries. Further, this handbook can be used as a convenient reference for issues that now frequently arise with subrogation and reimbursement claims and will enhance the management, administration, and recovery of such claims.

 

The 2018 edition of this manual updates changes to the law in all 50 states and the District of Columbia. Commentary and relevant case law pertaining to the Federal Employees Health Benefits Act and Medicare are found in the “Introduction” section of this manual. Information pertaining to ERISA follows. Here the reader will find selected case law pertaining to the preemption of state laws regarding subrogation, any made whole rule and the common fund doctrine. The final section of the manual examines state laws relevant to subrogation and reimbursement on a state-by-state basis. As the leading compilation of its kind, this manual is the perfect handbook to assist in the management, administration, and recovery of health plan subrogation and reimbursement claims.

 

The 22^nd Edition is available for purchase on Amazon.com through the following link:  https://www.amazon.com/dp/0991391586

Rawlings has been voted the second best place to work in Oldham County because we provide an outstanding foundation on which to build your career. We have state-of-the-art technology, competitive compensation and robust benefit offerings. At Rawlings, our most important competitive advantage is our people. We recognize the hard work they do every single day! Our people are equipped to succeed, and empowered to develop their career.

Some of the benefits of working for Rawlings include:

• A generous base salary as well as the potential for individual incentive income
• Medical, disability, vision and dental insurance packages
• A tuition reimbursement program for our employees
• A beautiful campus boasting an onsite coffee shop and café as well as a fully equipped work-out facility
• A tremendous opportunity for advancement. We help our employees grow within our organization by offering mentoring, leadership and professional development courses and a robust internal recruitment program. Our steady growth ensures that new management candidates are always in demand!