COB Smart. Council on Affordable Quality Healthcare (CAQH) Coordination of Benefits (COB) Data Now Included with Our Eligibility Response
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1 COB Smart Council on Affordable Quality Healthcare (CAQH) Coordination of Benefits (COB) Data Now Included with Our Eligibility Response Experian and the marks used herein are service marks or registered trademarks of Experian Information Solutions, Inc. Other product and company names mentioned herein are the trademarks of their respective owners. No part of this copyrighted work may be reproduced, modified, or distributed in any form or manner without the prior written permission of Experian.
2 Passport Partners With CAQH to Drive Cost Containment Passport s Data Services division has partnered with CAQH (Council on Affordable Quality Healthcare) to create COB Smart, a coordination of benefits (COB) repository that promotes cost containment across the commercial and governmentsponsored insurance industry. COB Smart : Registry of Coverage Information Updated weekly with participating Health Plans Data Purpose: Identify members with more than one form of coverage Determine correct order of Primacy CAQH offers payers the opportunity to match their member information within the COB Smart registry and receive accurate up-to date COB information at regular intervals. Online FAQ QHCOBSmartDataFAQs.aspx 2
3 CAQH is comprised of 12 Member Health Plans: Aetna AultCare Blue Cross Blue Shield of Michigan Blue Cross and Blue Shield of North Carolina BlueCross BlueShield of Tennessee Cigna Health Net, Inc. Horizon Healthcare Services, Inc. Kaiser Permanente UnitedHealth Group WellPoint, Inc., on behalf of its affiliated health plans CareFirst BlueCross BlueShield 3
4 COB Smart TM Benefits Providers and Payers Provider Benefits Access to richer eligibility responses that include more accurate COB information No process changes needed to gain access to this richer data - the standard 270/271 eligibility transaction currently used today includes the COB data Reduced Payer denials and errant payments Increased cash flow and reduced costs chasing COB information Payer Benefits Reduced staffing and administrative costs related to COB validation and recovery Increased accuracy in claim submission reducing administrative costs and incorrectly paid claims Reduction in COB inquires 4
5 COB Definition and Coverage Types 5
6 Full Response View COB Smart info is embedded in the eligibility response COB Smart data with Coverage type = Medical Care noted as Other or Additional Payer. Please note: If the COB info is for a different coverage type, it will appear in that coverage type section: please see next slide for more info. Note: Data Source = CAQH COB SMART 6
7 Mini Response View COB Smart info is embedded in the eligibility response CAQH COB Smart is found and identified as Primary 7
8 MyResponse Plan Tab COB Smart info is embedded in the eligibility response COB Smart in Third Party Payer section COB Smart in *NEW* Coordination of Benefits section 8
9 MyResponse My View Tab COB Smart info embedded in the Eligibility Response, added widgets to My View COB Smart in *NEW* Coordination of Benefits section COB Smart details in Third Party Payer section 9
10 *New* COB Widget for MyResponse Data Source = CAQH COB Smart Indicates for this instance, insurance is Primary Indicates that primacy was determined! Knowledge is POWER 10
11 11
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