Clearinghouse FAQs

COB Smart® gives clearinghouses access to the most complete source of information on individuals with multiple coverage and provides insight into primacy, which helps providers and clearinghouses determine payer responsibility. COB Smart enables participants to process claims correctly the first time.

The FAQs below explain why clearinghouses should consider COB Smart participation and how to get started.

What is COB Smart?      

COB Smart is an industry-wide solution that streamlines coordination of benefits (COB) processes. Different than other COB tools, COB Smart collects COB details directly from health plans. The registry of member health plan coverage is updated weekly and features a proprietary member-matching algorithm and built-in primacy rules engine. The solution matches members with multiple coverage by participating health plans, identifies the types of coverage overlaps, and provides insight into the proper order of health plan payment.

What are the benefits of COB Smart?   

COB Smart reduces the costs and burdens of healthcare administration and enables participants to process claims correctly the first time. The solution simplifies interactions between health plans and providers, while taking the patient out of the middle of claims processing.

Why should clearinghouses participate in COB Smart?                

COB Smart gives clearinghouses access to the most complete source of information on multiple coverage to determine primacy. Clearinghouses using the solution are able to provide coverage information to expedite eligibility and claims processes. Participation also demonstrates a commitment to administrative simplification – with direct, positive impacts on providers and patients.

How does COB Smart work?

Health plans send and receive member information to and from the COB Smart registry on a weekly basis (which aids in primacy determination and correct claims adjudication at a health plan level). Clearinghouses send 270 Inquiries to COB Smart participating health plans, and an additional inquiry to the COB Smart registry to determine if the member is associated with any other health plans participating in COB Smart. The clearinghouse can then share this information with its providers.

What coverage types does COB Smart include?

The majority of data is commercial coverage, but also includes Medicare Advantage, Medicare Part D, Medicare Supplement, and Medicaid MCO members. Included types of coverage will change in magnitude and distribution as additional health plans join COB Smart.

How does clearinghouse participation impact providers?

Many providers engage with clearinghouse partners to facilitate the 270/271 Eligibility and Benefits transactions on their behalf. Providers may use the eligibility information and COB information from COB Smart for discussion and action with their patients. Providers can file claims correctly based on accurate eligibility and benefits coverage information – both primary and secondary claims.

How do clearinghouses get started with COB Smart?

Clearinghouses enter into a Trading Partner Agreement with CAQH for COB Smart, and proceed through a brief testing and implementation phase. Once complete, a clearinghouse may then send inquiries to COB Smart, receiving real-time responses with coverage overlap and primacy determination to share with its provider clients.

What is the cost for a clearinghouse to participate in COB Smart?

CAQH shares COB Smart data with clearinghouses free of charge in exchange for clearinghouse distribution of COB data to providers in the HIPAA 271 response.

Who do I contact for more information?

Clearinghouses interested in learning more about COB Smart participation may contact cob@caqh.org.

 

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