Coordination of Benefits
COB is the process that determines which health care plan pays for services when a patient is covered by more than one. The member's contract language explains the order for which entity has primary responsibility and which entity has secondary responsibility for payment.
When you see Blue Cross and/or Blue Shield members who may have other health insurance coverage, provide them with the Coordination of Benefits Questionnaire. Send the completed questionnaire to the Blue Plan through which the member is covered.
If COB applies, the primary carrier's Explanation of Benefits (EOB) must be attached to the claim.
The following areas of the HCFA or CMS 1500 must be completed:
- Box 9: Other insured's name
- Box 9a-d: Other insured's policy or group number
- Box 11d: Mark "yes" unless Medicare or Medicaid is the primary insurer—then mark "no"
- Box 29: Amount paid
| if bcbsvt or any other blue plan is the primary payer: | if other non-blue health plan is the primary payer: |
|---|---|
| Submit other carrier's name and address with the claim to BCBSVT. |
Submit the claim to BCBSVT only after receiving payment from the primary payer, including the explanation of payment from the primary carrier.
|
