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COB Smart to Improve Accuracy of COB in the Health Care Industry

Blue Cross and Blue Shield of North Carolina (BCBSNC) is working with the Council for Affordable Quality Healthcare® (CAQH), a nonprofit alliance of health insurance payers and trade associations, to design a solution that improves the accuracy of coordination of benefits (COB) processes among health care payers, and creates greater efficiencies for providers.  

A number of the nation’s major health care payers are already participating in this initiative that will enable the health care system to correctly identify and coordinate COB status, by providing a secure resource that can more efficiently manage benefit information for patients with policies from more than one health care payer.

This resource is in the form of a new technology system called COB Smart™ that is being made available through CAQH to help make sure claims are handled by the correct health care payers and in the proper benefit determination order, so the COB process can work more smoothly for everyone. 

COB Smart is an electronic registry of coverage information that will correctly identify which patients have benefits that should be coordinated by more than one health care coverage payer.  Each week, participating health care payers will supply coverage information for the registry, where it will be compared with information from other participating health care payers to identify patients with more than one form of coverage.  Standard primacy rules are then applied to determine the correct order of benefits and reported back to participating health care payers. 

BCBSNC is committed to reducing administrative waste and simplifying health care administration by building and investing in new technology that simplifies processes, such as COB Smart.  Beginning this month, BCBSNC will start reporting and collecting COB information in the COB Smart program, in order to help improve COB coordination accuracy within the health care industry.

A growing number of health care payers are participating with BCBSNC in the COB Smart initiative, including Aetna, AultCare, Blue Cross and Blue Shield of Michigan, BlueCross BlueShield of Tennessee, CareFirst BlueCross BlueShield, Cigna, Health Net, Inc., Horizon Healthcare Services, Inc., Kaiser Permanente, UnitedHealth Group, and WellPoint, Inc., on behalf of its affiliated health plans.

We’re asking providers not to make changes to their current business processes for reporting and filing claims for patients who have coverage with more than one health care payer.  Providers should also not see a change by BCBSNC in our handling of COB claims.  When BCBSNC is notified by COB Smart that a member may have primary coverage with another health care payer, BCBSNC will research the member’s COB situation to make a determination. If it’s identified that we are secondary to another health care payer and no primary insurance payment information was submitted with a claim for that member, BCBSNC will return an electronic eligibility response to the submitting provider (or via remark code on the explanation of payment for paper claim filers,) and request that primary insurance payment information be provided. 

Information provided to us through the COB Smart registry will be used to supplement our existing tools for managing COB information for members enrolled in our commercial and Medicare Advantage lines of business.  State Health Plan membership and members of the Federal Employees Program will not be included in the COB Smart initiative at this time.     

If you have questions about BCBSNC’s participation with the new COB Smart initiative, please contact your BCBSNC Network Management representative for assistance.