Coordination of Benefits (COB) has proved challenging for the healthcare industry, resulting in delayed and inaccurate payments, appeals and significant recovery activities.

CAQH COB, 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. 

CAQH COB helps clearinghouses deliver coordination of benefits information that can easily be incorporated into a standard 271 eligibility response. The solution’s information registry correctly identifies the patients with multiple sources of coverage, so that corresponding claims can be handled correctly the first time. COB Smart is available to clearinghouses at no charge.

• Informative. Identifies new or previously unknown instances of overlapping coverage to determine which health plan should pay first.
• Cost-Effective. Reduces administrative costs and complex workflows when determining coverage.
• Smart. Features a built-in primacy rules engine to determine the correct order of benefits.
• Secure. Contains strong industry standard administrative, technical and physical safeguards to maintain patient privacy and comply with HIPAA and patient privacy requirements.
• Collaborative. Designed for industry-wide participation. Health plans directly contribute member information to a shared registry. The greater the amount of shared health plan data, the better the COB outcome. 

How CAQH COB Works

Participating health plans supply information to the registry each week, where it is compared with data from other health plans to identify patients with more than one type of coverage.  Rules are applied to determine the correct order of primacy for benefit coverage. Relevant coverage information is then shared with each participating health plan and is also accessible to providers. This information is contained in a 271 response segment specific to COB information.  

Why Use CAQH COB?

CAQH COB enables clearinghouses to provide a value-added service to providers at no additional cost. Timely, automated COB information increases efficiency and helps reduce:

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

CAQH COB Benefits for Medical Claims Clearinghouses

• Provides access to the most complete source of information on multiple coverage to determine primacy, streamlining investigative processes.
• Saves money by reducing unnecessary, duplicative or delayed processing of healthcare claims.
• Helps improve provider service by offering them the most complete coverage information available to expedite eligibility and claims processes.
• Integrates with existing tools and workflow processes to confirm a patient’s eligibility, helping to increase payment accuracy, improve cash flow and reduce accounts receivable balances.
• Simplifies administrative processes with less paperwork for a direct, positive impact on providers and patients.