CAQH leverages a continuously updated registry of coverage data on 225 million members to enable plans to coordinate benefits before claims are paid, reducing errors and increasing cost avoidance.
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.
A proactive strategy to coordination of 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.
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.
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.
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.
The CAQH COB solution meets key healthcare regulations and requirements for protecting and securing sensitive private healthcare information.