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Horizon BCBS Deploys Coordination of Benefits Tool

Greg Goth

Health Data Management

MAR 20, 2014





Horizon Blue Cross Blue Shield of New Jersey, Newark, has begun to use COB Smart, a national registry that is currently identifying coordination of benefits for more than 100 million patients. The tool has been designed for industry-wide adoption; Horizon BCBSNJ is one of 12 major health plans--covering more than 165 million lives--participating in the registry.

The registry was launched in February 2014 by CAQH, a non-profit alliance of health plans and trade associations. In a statement announcing the plan's launch of the tool, Horizon BCBSNJ said the technology will allow it to streamline COB processes, better ensure accurate payments to providers, and improve the health care experience for members.

The organization says the system is designed to enable providers, once it becomes available to them in the summer of 2014, to access complete and accurate benefits coordination for their patients.

Participating health plans using COB Smart include Aetna; AultCare; Blue Cross and Blue Shield of North Carolina; BlueCross BlueShield of Tennessee; CareFirst BlueCross BlueShield; Cigna; Health Net, Inc.; Horizon Healthcare Services, Inc.; Kaiser Permanente; UnitedHealthcare; and WellPoint, Inc., on behalf of its affiliated health plans. Each of these health plans has committed to adopt COB Smart.

COB Smart

Difficulties associated with the coordination of benefits process — from manual processes to prolonged and error-prone payment cycles — make the healthcare system cumbersome for patients with multiple sources of coverage and have burdened the healthcare industry for decades. Reliably and quickly determining the correct order of benefits for individuals insured by more than one policy improves claims processes across the system.

CAQH and a number of major health plans have designed and launched COB SmartTM, a solution that improves the accuracy of coordination of benefits processes. COB Smart is rolling out on a market-by-market basis and will be nationwide later in 2014.

Get It Right the First Time

COB Smart is unique. Health plans directly contribute to a registry of coverage information that helps health plans and providers correctly identify which members have benefits that should be coordinated in order for corresponding claims to be processed correctly the first time.

Each week, participating health plans supply coverage information to the registry, where it is compared with information from other participating health plans to identify members with more than one form of coverage. Standard primacy rules are then applied to determine the correct order of benefits and the information is returned to the applicable health plans. CAQH is also working with leading clearinghouses and other solution partners to integrate COB Smart into the provider workflow.

The solution is HIPAA-compliant with strong administrative, technical and physical safeguards to maintain patient privacy.

Participate in COB Smart

COB Smart is designed for industry-wide participation.

A number of the nation's major health plans are already participating - and the registry is identifying COB for more than 100 million patients today. Additional health plan participation will amplify the impact of the initiative on streamlining the coordination of benefits process for all stakeholders.

COB Smart is designed to easily integrate with most existing provider office workflows and will be available through clearinghouses. Initially, COB Smart is available through Passport's OneSource solution. Check back here for updates or contact your clearinghouse for more information about their plans for utilizing the CAQH COB Smart product.

Contact to learn more about participation.  CAQH is the Council for Affordable Quality Healthcare is a non-profit alliance of health plans and trade associations, working to simplify healthcare administration through industry collaboration on public-private initiatives



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