CAQH Coordination of Benefits

Enhanced Payment Integrity

The CAQH coordination of benefits solution identifies primary and secondary coverage with 99.5 percent accuracy and determines primacy weekly – before claims are paid. This unique and prospective approach to COB allows plans to significantly enhance their payment integrity programs.

225M+

covered lives

99.5%

validated identification of medical and pharmacy overlaps

100%

national health plan participation

31%

average increase in new secondary coverage identification

Lower Administrative Costs

After-the-fact coordination of benefits programs, commonly referred to as “pay and chase,” can be both expensive and ineffective. The CAQH COB solution reduces the costs associated with member canvassing for other coverage, claims denials, resubmissions and recovery. After implementing the CAQH COB solution, one national health plan achieved an 80:1 return on investment.

Large National Health Plan Achieves $200M in Medical Cost Reduction with CAQH Coordination of Benefits

One of the nation’s largest health plans decreased administrative costs by more than $50 million annually and increased medical cost savings by $200 million for its commercial, Medicaid and Medicare Advantage business lines.

How 25 Blue Cross Blue Shield plans use CAQH COB data to pay claims correctly the first time

Inefficient coordination of benefits processes cost the US healthcare system more than $800 million annually. Too often health plans do not have access to timely information about overlapping coverage, and instead attempt to recover erroneous payments after a claim has been paid.

How Prospective Coordination of Benefits Reduced Vendor Spend by $42M Annually

By taking a prospective approach to coordination of benefits, one of the nation's largest health plans was able to automate its internal processes and reduce spend on recovery vendors, saving $42M annually.

Calculate What Your ROI Could Be

COB Smart meets key healthcare regulations and requirements for protecting and securing sensitive private healthcare information.

A Better Member Experience

Recovery vendors and programs send letters and call members to inquire about other health coverage. This can be a nuisance to members, yields limited or incorrect information and is now unnecessary. With advanced data matching and validating technologies, the CAQH COB solution provides plans with better information while eliminating the need for this inconvenience to members.

Blues Plan in the Northwest

“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.”

Mid-Atlantic region Health Plan

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

Blues Plan in the Northwest

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

A regional BCBS plan

"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.”

Get Ahead of It.

Coordination of benefits before claims are paid results in greater payment accuracy, a better member and provider experience, and more streamlined health plan operations

Learn how