Claims Coordination & Review

Quick payment with coordination of benefits

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.

Log in to submit an electronic COB claim

There are two types of COB claims you can send electronically:

• Commercial insurance claims in which another payer is primary and Aetna is secondary
• Medicare primary claims for which Medicare* has not already forwarded their claims and payment information to us

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.

Use one of our vendors to submit COB claims

Or use our secure provider website

*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 Smart^TM, 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.

Visit the CAQH website for more information on COB Smart

If you share our COB form with your patients, it will help you collect the data you need.

Patient COB form

How to refund an overpayment

If we identify an overpayment

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 identify an overpayment

If you received an overpayment, please submit the following information:

• A check issued to Aetna in the amount of the overpayment
• The name and ID number of the member for whom we have overpaid (Include a copy of the member's Aetna ID card, if available.)
• The dates of service
• Supporting documentation, including but not limited to:
  • A letter explaining the reason for the refund
  • A copy of your Explanation of Benefits (EOB) statement
  • In the case of incorrect coordination of benefits, the primary carrier's EOB statement
  • Corrected bill
  • Any other documentation that would assist in accurate crediting of the refund

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:

Aetna Inc.
PO Box 14079
Lexington, KY 40512-4079