System and method of facilitating the coordination of benefits for a plurality of health plans

A system of facilitating the coordination of benefits for a plurality of health plans that individually have at least some responsibility to pay for healthcare services received by members covered by more than one health plan, the coordination of benefits being made prior to payment for the healthcare services, the system comprising:

• one or more processors configured to execute one or more computer program modules, the one or more computer program modules comprising:
• a health plan information module configured to obtain:
• (i) a first set of member information that describes a member covered by a first health plan, (ii) a first set of coverage information that describes the first health plan in relation to the member covered by the first health plan, (iii) a second set of member information that describes a member covered by a second health plan, and (iv) a second set of coverage information that describes the second health plan in relation to the member covered by the second health plan;
• a member matching module configured to determine that the first set of member information, the first set of coverage information, the second set of member information, and the second set of coverage information relate to a particular member that is covered by both the first health plan and the second health plan based on the first set of member information and the second set of member information;
• and
• a coordination of benefits module configured to:
• generate one or more coordination of benefits records that indicates that the particular member is covered by both the first health plan and the second health plan based on the determination, the one or more coordination of benefits records comprising:
• (i) at least a portion of the first set of coverage information, (ii) at least a portion of the second set of coverage information, and (iii) a member identifier that identifies the particular member;
• and
• provide, by the coordination of benefits module, the one or more coordination of benefits records.

A computer readable medium comprising executable code for facilitating the coordination of benefits for a plurality of health plans that individually have at least some responsibility to pay for healthcare services received by members covered by more than one health plan, the coordination of benefits being made prior to payment for the healthcare services, the computer executable code, when executed by one or more processors, causing the one or more processors to:

• obtain:
• (i) a first set of member information that describes a member covered by a first health plan, (ii) a first set of coverage information that describes the first health plan in relation to the member covered by the first health plan, (iii) a second set of member information that describes a member covered by a second health plan, and (iv) a second set of coverage information that describes the second health plan in relation to the member covered by the second health plan;
• determine that the first set of member information, the first set of coverage information, the second set of member information, and the second set of coverage information relate to a particular member that is covered by both the first health plan and the second health plan based on the first set of member information and the second set of member information;
• generate one or more coordination of benefits records that indicates that the particular member is covered by both the first health plan and the second health plan based on the determination, the one or more coordination of benefits records comprising:
• (i) at least a portion of the first set of coverage information, (ii) at least a portion of the second set of coverage information, and (iii) a member identifier that identifies the particular member;
• and
• provide, by the coordination of benefits module, the one or more coordination of benefits records.