What is coordination of benefits cob claim

We recently identified provider billing discrepancies regarding the Claim Adjustment Reason Codes and Group Code compatibility on claims. Billing claim adjustment group code Contractual Obligation CO in conjunction with claim adjustment reason codes that indicate the amount is patient responsibility e. If you have questions about submitting electronic COB claims, please contact your software vendor or software support. Your patient should complete our member COB questionnaire when covered by more than one health insurance policy.

This will help us process claims correctly. This form is available on the BridgeSpan Health member website. A claim could be held for possible other party liability review OPL for multiple reasons.

Reasons may include:. If a claim is held for accident information from the member, the member needs to follow directions indicated on the letter he or she received from us or from our contracted vendor. This will consist of either an incident report, or a letter to call our vendor to provide information about the claim that is considered a potentially a third-party situation.

When an accident investigation is created, claims related to those services will pend in our claims system for up to 25 days. If the information is not received within 25 days, the investigation will close with the claim remark indicating information is required from the member. You have custody of your 8-year-old son.

You hit a deer with your car, hurt your knee and need to go to a doctor. Michigan auto insurance policies must include coverage for car-related injuries, called personal injury protection. But in most cases your health insurance is primary.

So your health plan will pay first, and if there are expenses left over not covered by your plan, your auto insurance will pay those. Connecticut State Office of the Healthcare Advocate. How it Works First, the primary plan pays your claims as if there were no other insurance. In determining which plan is primary and which is secondary, a plan without a COB provision is generally considered primary.

When both have COB rules, the plan in which you are enrolled as an employee or as the main policyholder is primary.

The plan in which you are enrolled as a dependent - on your spouse's plan - would be secondary. In addition, if you have COBRA coverage as well as coverage with another plan in which you are enrolled through an employer, your COBRA plan is secondary and your employer's plan is primary. The " Birthday Rule " applies only to children.