What is CAQH Coordination of Benefits?

Coordination of Benefits (COB) has been a persistent challenge for the healthcare industry, resulting in delayed and inaccurate payments, appeals and significant recovery activities and expenses. 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.

How does CAQH Coordination of Benefits work?

Participating health plans supply information to the CAQH COB registry each week, where it is compared with data from other health plans to identify patients with coverage from more than one plan. National Association of Insurance Commissioners' (NAIC) rules are applied to determine the correct order of primacy for benefit coverage. Relevant information is then shared with each participating health plan that insure the member and is also accessible to providers so they can route claims correctly. 

Why use CAQH COB?

CAQH Coordination of Benefits streamlines benefit coordination for health plans, providers and patients. Timely and accurate COB information produced by CAQH COB increases efficiency and helps to reduce:

• Administrative costs
• Inaccurate payments
• Member and provider call volumes
• Claim rework
• Dependency on overpayment and recovery vendors

Who should use CAQH COB?

CAQH COB can be used by many types of health organizations:

• Health Plans
• State Sponsored Programs
• Clearinghouses

Who can I contact for help or if I have any questions about CAQH COB?

To learn more about reducing the challenges and costs associated with coordination of benefits, contact your CAQH representative or email: COB@caqh.org.