Coordination of Benefits -Claim denied as need to update COB

What is the Coordination of benefit?

Coordination of Benefits -In general, the patient has many plans like a primary plan, secondary plan, Tertiary plan. These plans are Coordinated and Provisioned By  Coordination of benefits. In short, This is to avoid the duplication of benefits. When a patient moves from one insurance to another insurance they have to update the coordination of benefits. This Cob information says the order of the insurance who is the primary and who is secondary.

Example

Let’s say David has united healthcare as active insurance and suddenly he changed to another insurance “x” for its benefits. Now you will call the united healthcare for claim status. But united healthcare denies payment and says David moved to another responsible payor.

What can be the reason for denial? Any guesses??

Answer

David failed to update the new policy information that has chosen recently. This is the case David has to update the COB(Coordination of Benefits ) That shows  Active insurance as of now and the one who can cover the bills. Cob can also show the order of primary and secondary insurance.

 

Steps to be followed for Coordination of benefits denial

1. Firstly, check the insurance denied is primary or secondary. This can be done using the respective software

2.If the insurance is Primary. Make a call to the insurance company and probe for the payment. If insurance says they are not the primary ask who is primary. Get all the necessary information from the rep.

3.Call the responsible payor and confirm whether they are the primary insurance for the patient. If they are the one bills the claim to them.If not ask for the patient to Update the Coordination of benefits.

4.Secondly, if you find the denied insurance is secondary. Simply Appeal the claim with primary EOB to process the claim.

Questionnaire Flow chart for Coordination of benefit

Denied for Co-ordination of benefits

Read more ——>CO 51 Pre-existing condition denial scenario and the solution

1 thought on “Coordination of Benefits -Claim denied as need to update COB”

Leave a Comment