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Accurately Coordinate Benefits with Better Data

CAQH leverages a continuously updated registry of coverage data on over 235 million members to enable plans to coordinate benefits before claims are paid, reducing errors and increasing cost avoidance.

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How to Build a Proactive COB Program

The pay and chase approach to coordinating benefits leads to a manual and time-consuming process for you and frustration for providers and members. A prospective Coordination of Benefits (COB) program can prevent incorrect payments, increase efficiency and positively impact the full payment integrity process.

Download the Issue Brief
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Drive Payment Integrity.

A proactive strategy for coordinating benefits can improve a health plan’s bottom line with positive impacts on the entire payment integrity process. In the past, access to timely and accurate COB data has been the missing piece to improve the claims management lifecycle.

Calculate Your Potential ROI

Improve Coordination of Benefits with Data.

Access real-time primary and secondary coverage data with 99.5 percent accuracy. 

Fact Sheet
See the Trends

CAQH Coordination of Benefits at a Glance

235 M+

Covered Lives

included in the CAQH member data registry

99.5 %

Accuracy

of validated coverage overlaps

100 %

of National Health Plans

participate in the CAQH Coordination of Benefits solution

10 : 1

Average ROI

reported by health plans

Keeping Member Data Secure

Safeguarding member data is critical to maintaining trust and ensuring compliance between health plans, members, and providers. The CAQH Coordination of Benefits solution employs a comprehensive, three-pronged approach to data security, combining administrative, physical, and technical measures. Learn how CAQH secures member data and why we are a trusted data partner for more than 235M+ covered lives.

See Our Approach
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Data Validation

The data validation service reduces the cost and manual effort required to validate coverage identified by CAQH Coordination of Benefits solution, maximizing improvements in payment accuracy and administrative savings.
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COB for Pharmacy

Currently, 10 percent of members nationwide with commercial coverage and 15 percent of people enrolled in Medicare Advantage plans have overlapping pharmacy coverage. Given the high cost of drugs, an effective pharmacy coordination of benefits program can yield substantial savings.

Discover the Benefits.

"With the CAQH COB solution we save $345.40 per member per month on commercial COB and more than $1,200 on Medicare."

A National health plan

“The product sells itself! Add to that a transparent pricing model and outstanding support in our account team as well as IT support and guidance from CAQH.”

Blues Plan in the Northwest

“Using the portal for investigations has reduced processing times and claim holds by three days.”

Mid-Atlantic region Health Plan

“The first year the product paid for itself in two months and by the fifth month it paid for two years.”

Blues Plan in the Northwest

"The plan decreased the instances where they would pay primary by 17 percent and increased the claims where they would pay secondary by 64 percent.”

A regional BCBS plan

CSF Certified

The CAQH COB solution meets key healthcare regulations and requirements for protecting and securing sensitive private healthcare information.

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Get ahead of it

Prospective coordination of benefits results in greater payment accuracy, a better member and provider experience and streamlined health plan operations.

Learn How