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Surescripts
Accurately identify payment responsibility
Identify Medicaid and other plan members with multiple prescription benefit coverages and determine third-party liability in seconds. With Coordination of Benefits, health plans and the technology vendors that serve them can ensure claims are paid correctly the first time. Avoid overpaying pharmacy claims and adjudicate them swiftly and appropriately.
13%
of the total U.S. population had multiple coverages in 20211
>15%
of Medicaid enrollees are also covered by Medicare2
$20 million
of estimated savings for U.S. health plans by adopting electronic coordination of benefits3
What can Coordination of Benefits do for you?
See how Coordination of Benefits can help health plans avoid the pay-and-chase process up front, recoup previously paid claims and improve payment integrity.
Identify payment responsibility for members with multiple coverages
Receive primary and secondary prescription benefit coverage information in real time. Coordination of Benefits helps health plans accurately identify primary payment responsibility for members with multiple coverages.
Support member care and satisfaction
Help plan members avoid confusion and unexpected out-of-pocket costs that come with juggling multiple coverages.
Reduce costs
Ensure payments are made by the member’s appropriate source of coverage, reducing pharmacy claims that are overpaid by your health plan.
Avoid manual work
Reduce phone calls, faxes, time and frustration by avoiding the need to recoup overpaid prescription drug claims.
Match patients accurately
Submit requests to check member benefit information with confidence, knowing the Surescripts Master Patient Index makes accurate matches in milliseconds.
How it works for health plans
A member of a government-sponsored plan enrolls or has a pharmacy claim.
Submit a request to check benefit information and get an accurate match in an average of 38 milliseconds.4
Surescripts returns information on all additional coverages for the member.
You can see the prescription benefit coverage of the member, including whether they are on a Medicaid plan.
Use the coverage information to adjudicate claims swiftly and appropriately.
With complete coverage information, you can avoid overpayment up front and streamline post-payment recovery.
Keep pace with healthcare innovation
- Laryssa Mykyta et al., “About 43 Million People in the U.S. Had Multiple Health Plans in 2021,” Census.gov, July 19, 2023.
- “Seniors & Medicare and Medicaid Enrollees,” Medicaid.gov, accessed April 22, 2025.
- CAQH, “2024 CAQH Index Report,” February 2024, p. 37.
- Surescripts, “Annual Impact Report 2024,” March 2025, p. 5.
Connect with our team to explore how we can partner to increase patient safety, reduce costs and ensure quality care.
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