Coordination of benefits (COB) helps to determine which company is primarily responsible for payment. It occurs when a patient is covered under more than one insurance plan. This process lets your patients get the benefits they are entitled to. It also helps to avoid overpayment by either plan and gets you paid as quickly as possible.
When a patient comes to you, you can submit an eligibility and benefits inquiry. We will inform you if the patient is covered and which plan is primary.
There are two types of COB claims you can send electronically:
Contact the practice management support team and/or the clearinghouse you use to submit your electronic claims. They may have their own guidelines or tips about submitting COB claims.
*We can accept both Medicare Part A and Part B claims electronically from Medicare. If the Medicare electronic remittance advice (ERA) or Explanation of Payment (EOP) contains an "MA18" or "N89" remark code, the Medicare carrier has automatically sent us your claim. In these cases, you don't have to send us a Medicare primary COB claim.
We participate in COB SmartTM, a Council for Affordable Quality Healthcare® solution. COB Smart is rolling out on a market-by-market basis and will be nationwide later in 2014.
If you share our COB form with your patients, it will help you collect the data you need.
If we have identified an overpayment and request a refund, please mail the check, along with a copy of the overpayment request letter we sent you, to the address provided in the letter.
If you received an overpayment, please submit the following information:
Mail this information to the address on the EOB statement or on the member's ID card. Once we receive the information, we will correct the member's file.
If the EOB statement or the member's ID card is not readily available, send information to:
PO Box 14079
Lexington, KY 40512-4079