- 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
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- CAQH ProView for Groups
- CAQH ProView - Dental
- Provider Directory - DirectAssure
- Credentialing Solutions Suite
- COB Smart
COB Smart for Medicaid Plans
Stretch existing resources by identifying third party liability before a claim is paid.
How COB Smart® works
Participating health plans supply information to the COB Smart registry each week, where it is compared with data from other health plans to identify members with overlapping benefits. National Association of Insurance Commissioners’ (NAIC) rules are applied to determine the primacy of benefit coverage. This information is then shared with each participating health plan so it may be integrated into their existing workflows.
Providers may also access COB Smart information so they can route claims to responsible health plans correctly.
A Road Map to Improved COB/TPL Compliance
Improper Medicaid payments, such as for ineligible patients or for services not provided, were estimated to be $36.2 billion in fiscal 2018, accounting for 9.8 percent of Medicaid spending. The road to accountability is only growing more complex. Payers, especially Medicaid and MCO plans, cannot succeed without a strong strategy for effective COB/TPL. Read more.
COB Smart Benefits for Medicaid Plans
- Offers the only national coverage database of information supplied by health plans on a weekly basis.
- Delivers access to the most complete source of information on multiple benefits coverage to determine primacy.
- Eliminates vendor conflict of interest by separating COB identification and recovery.
- Prevents inaccurate claims payments by giving data to health plans on a prospective basis (before a COB event occurs).
- Reduces the costs associated with member canvassing for other coverage, claims denials, resubmissions and recovery.
- Simplifies budgeting for COB operations with a predictable, per member fee.
- Helps improve customer service and eligibility and claims processes.
- Integrates with existing health plan systems to automate and streamline COB information exchange.