Difficulties associated with the coordination of benefits process - from manual processes to prolonged and error-prone payment cycles - make the healthcare system cumbersome for patients with multiple sources of coverage and have burdened the healthcare industry for decades. Reliably and quickly determining the correct order of benefits for individuals insured by more than one policy improves claims processes across the system.

COB Smart^® takes a radically different approach to coordination of benefits. Health plans directly contribute to a registry of coverage information that helps health plans and providers correctly identify which members have benefits that should be coordinated in order for corresponding claims to be processed correctly the first time.

Each week, participating health plans supply coverage information to the registry, where it is compared with information from other participating health plans to identify members with more than one form of coverage. Standard primacy rules are then applied to determine the correct order of benefits and the information is returned to the applicable health plans. CAQH is also working with leading clearinghouses and other solution partners to integrate COB Smart into the provider workflow.

The solution is HIPAA-compliant with strong administrative, technical and physical safeguards to maintain patient privacy.

Participate in COB Smart

COB Smart easily integrates with most existing provider office workflows and is also available through clearinghouses. Check here for a list of participating partners or contact your clearinghouse for more information about their plans for utilizing the CAQH COB Smart product.

Interested health plans or clearinghouses can contact COB@caqh.org to learn more about participation. Healthcare providers should contact their practice management or clearinghouse provider about ways to obtain COB Smart information.

Creating a Better Member Experience

When Coordination of Benefits is handled poorly and health plans rely on members to fill in the blanks or help correct errors, it puts the member “in the middle" of the operational function, whether through data collection, billing or claims adjudication and adjustment. Read more.