- About CAQH CORE
- Operating Rules
- New Operating Rule Structure
- Eligibility & Benefits
- Claim Status
- Payment & Remittance
- Prior Authorization & Referrals
- Health Care Claims
- Benefit Enrollment
- Premium Payment
- Mandated Operating Rules
- CORE Certification
- Priority Topics
- Join CAQH CORE
- Resource Library
- CAQH ProView
- CAQH ProView for Groups
- CAQH ProView - Dental
- Provider Directory - DirectAssure
- Credentialing Solutions Suite
- COB Smart
COB Smart for Health Plans
Accurate Benefits Coordination. Get It Right the First Time Around.
Coordination of Benefits (COB) has proved challenging for the healthcare industry, resulting in delayed and inaccurate payments, appeals and significant recovery activities.
COB Smart is a forward-thinking solution that enables health plans and providers to correctly identify which members have benefits that should be coordinated. This way, corresponding claims are processed correctly the first time.
- Informative. Identifies new or previously unknown instances of overlapping coverage to determine which health plan should pay first.
- Cost-Effective. Reduces administrative costs and complex workflows when determining coverage.
- Smart. Features a built-in primacy rules engine to determine the correct order of benefits.
- Secure. Contains strong industry standard administrative, technical and physical safeguards to maintain patient privacy and comply with HIPAA and patient privacy requirements.
- Collaborative. Designed for industry-wide participation. Health plans directly contribute member information to a shared registry. The greater the amount of shared health plan data, the better the COB outcome.
Learn more about how your organization would benefit from COB Smart:
How COB Smart Works
Participating health plans supply information to the registry each week, where it is compared with data from other health plans to identify patients with more than one type of coverage. Rules are applied to determine the correct order of primacy for benefit coverage. Relevant coverage information is then shared with each participating health plan and is also accessible to providers.
Why use COB Smart?
COB Smart streamlines benefit coordination for health plans, providers and patients. Timely and accurate COB information produced by COB Smart increases efficiency and helps reduce:
- Administrative costs
- Inaccurate payments
- Member and provider call volumes
- Claim rework
- Dependency on overpayment and recovery vendors
COB Smart Benefits for Health Plans
- Provides access to the most complete source of information on multiple coverage to determine primacy, streamlining investigative processes.
- Saves money by reducing the costs associated with claims denials, resubmissions and recovery.
- Helps improve provider service by offering them the most complete coverage information available to expedite eligibility and claims processes.
- Integrates with existing systems to automate and streamline COB information exchange.
- Simplifies administrative processes with less paperwork for a direct, positive impact on providers and patients.