Coordination of Benefits
Last Updated on January 24, 2019
Coordination of Benefits (COB)
- If a member carries other insurance through more than one insurer, Security Health Plan will coordinate the benefits to ensure maximum coverage without duplication of payments.
- The affiliated provider must submit claims to the primary carrier before submitting to Security Health Plan. After a claim is submitted to the primary carrier, a claim for the balance should be submitted to Security Health Plan along with either an Explanation of Benefits (EOB) or electronic payment/denial information. The affiliated provider must submit the balance within 180 days from the date on the EOB.
- If the affiliated provider fails to comply or is unaware of the primary insurance carrier, claims for which Security Health Plan is secondary will be denied using ANSI code 22. This denial reason will print on the affiliated provider’s reimbursement statement.
- If a primary insurance is discovered after charges have been processed and the primary insurance makes payment, the affiliated provider might then have an overpayment. If the affiliated provider is overpaid due to primary insurance payment, the affiliated provider should complete an adjustment request form and send it along with a copy of the original claim and a copy of the EOB from the primary insurance. Claims will be reprocessed based on the primary insurance payment. The adjustment will be reflected on the affiliated provider’s reimbursement statement.
- If Security Health Plan discovers a primary insurance after charges have been processed, Security Health Plan will reverse its original payment. The adjustment will be reflected on the affiliated provider’s statement using ANSI 22.
- If the primary insurance denies a claim because of lack of information, Security Health Plan will also deny.
- If the affiliated provider has any questions regarding coordination of benefits, call 715-221-9503 or 1-800-548-4831 Monday through Friday, between 8:00 a.m. and 4:30 p.m.
To assure a claim will be processed correctly and in a timely manner by Security Health Plan:
- If Security Health Plan member has Medicare and another insurance, complete information must be on the CMS 1500 claim or UB-04 claim for the claim to be processed efficiently.
- On the CMS 1500 claim, box 11d should be checked “Yes” if there is any other insurance information. If box 11d is checked “Yes”, boxes 9a – 9d on the CMS 1500 claim must be completed with the other insurance information.
- On the UB-04 claim, box 50 is completed if there is any other insurance information.
- EOB's or electronic payment/denial information needs to accompany each CMS 1500 claim and UB-04 claim where other insurance is indicated on the claim.