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A More Effective Way to Coordinate Benefits

CAQH leverages a continuously updated registry of coverage data on over 236 million members to enable plans to coordinate benefits before claims are paid, reducing errors and increasing cost avoidance.

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 COB program can prevent incorrect payments, increase efficiency and positively impact the full payment integrity process.

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.

A prospective approach

The CAQH Coordination of Benefits Solution identifies primary and secondary coverage with 99.5 percent accuracy weekly. This prospective approach is more effective than retrospective recovery efforts and allows plans to achieve a higher standard of payment integrity.

CAQH at a Glance

236 M+

Covered Lives

included in the CAQH member data registry

99.5 %

of overlaps

in medical and pharmacy coverage are validated

100 %

of National Health Plans

participate in the CAQH Coordination of Benefits Solution


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.

One large health plan began using the data validation service and realized an 8X increase in savings.

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.

The CAQH Coordination of Benefits Solution for pharmacy helps plans identify primary and secondary coverage and determine primacy weekly, before claims are paid, to increase payment accuracy and reduce administrative costs associated with recovery.

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40 M

Members with pharmacy data in the CAQH registry of coverage information

57 %

Of overlaps determined by CAQH include primacy information to streamline COB

"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.


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