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Claims coordination and review

Find helpful information when your patient is covered by more than one health plan.

Quick payment with coordination of benefits

 

Coordination of benefits (COB) is a process that identifies which health plan is primary when a patient has more than one plan. This is important for your patient, so they receive the benefit they’re entitled to. It also helps the health plan pay claims quickly and correctly.

 

Before your patient’s visit: Helpful tips

 

  • Use the Aetna® provider portal on Availity to submit an eligibility and benefits inquiry. You can also use your preferred vendor or clearinghouse. We’ll inform you if your patient is covered and which plan is primary if we have those details. 
  • Ask your patient for copies of their current ID cards. Ask if they have more than one plan.
  • When your patient has more than one plan, be sure to get the insurance health plan company name, policyholder name, member ID and employer name for each plan.
  • Advise your patient to inform Aetna of other coverage. They can use their member website to complete the “Your other health plans” form found in the support menu.
  • Encourage your patient to contact each health plan to provide COB information for themselves and family members covered under their plans.

During the claims process: Next steps

 

  • Step 1: Bill the primary insurance company.
  • Step 2: Review the primary insurance company’s explanation of benefits (EOB).
  • Step 3: Bill the secondary insurance electronically.

When Medicare is primary: We 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 “MA 18” or “N89” remark code, the Medicare carrier has automatically sent us your claim. In these cases, you don’t need to send us a Medicare primary COB claim.

 

Learn how easy it can be to submit electronic claims

A helpful guide created just for health care providers. 

 

Electronic claim submission guide (PDF)

 

Share our tip sheet with the vendor you use to submit claims

Filing tips for billing companies, vendors and clearinghouses. 

 

COB billing tips (PDF)

When a COB claim is pended: What to expect 

 

If we receive COB information that doesn’t match what’s in our system, or if it’s the first time we receive COB information, we must verify coverage with the other plan. This may take up to 45 days. 

 

We work with other health plans to validate patient coverage by participating in COB Smart, a Council for Affordable Quality Healthcare© solution.

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