A pilot project to ease identification of patients who have insurance coverage from more than one payer is expanding nationwide.
The goal is to make coordination of benefits easier for insurers, providers and patients. Industry advocacy group CAQH worked with 11 national and large regional insurers in 2013 to develop COB Smart, and went live in 15 states in February 2014. Now, the program is being offered in all 50 states and the District of Columbia, starting with the original payers while recruiting other insurers not yet on board.
Participating insurers include: Aetna, AultCare, Blue Cross and Blue Shield of North Carolina, BlueCross BlueShield of Tennessee, CareFirst BlueCross BlueShield, Cigna, Health Net, Horizon Healthcare Services, Kaiser Permanente, United Healthcare and WellPoint (soon to be called Anthem). Together, they have populated a registry holding insurance data on 110 million covered lives.
The registry returns matched and validated data in an electronic file to insurers on a weekly basis, enabling them to more easily identify patients eligible for coverage under more than one plan, and which plan pays first. Now, CAQH has added portal technology for a second way to determine COB for payers who want to conduct individual member queries.
Claims clearinghouse Passport has operated the registry and now CAQH is reaching out to other clearinghouses to offer the service to payers and providers. Clearinghouses can support a providers workflow by transmitting a HIPAA 271 eligibility response transaction that includes COB information, says Sorin Davis, managing director at CAQH. This will enable providers to identify the primary payer and send the claim to the correct payer the first time.
The degree to which COB Smart services are available across the nation varies by state right now but will only improve as more insurers get on board, Davis says. There is no downside; whatever level is available is more than providers had.
Davis advises providers to ask their clearinghouses about plans for supporting COB Smart. To learn more or participate, send an email to COB@caqh.org.
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