{"id":14543,"date":"2021-11-18T17:38:01","date_gmt":"2021-11-18T17:38:01","guid":{"rendered":"https:\/\/www.medicalbillersandcoders.com\/blog\/?p=14543"},"modified":"2025-05-07T09:12:39","modified_gmt":"2025-05-07T09:12:39","slug":"manage-coordination-of-benefits-cob-denials","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/manage-coordination-of-benefits-cob-denials\/","title":{"rendered":"Manage Coordination of Benefits (COB) Denials"},"content":{"rendered":"

Centers for Medicare & Medicaid Services (CMS) defines coordination of benefits (COB), as the process which allows plans that provide health and\/or prescription coverage for a person with Medicare to determine their respective payment responsibilities. <\/span><\/p>\n

In simpler words, COB determines which insurance carrier is primary, secondary, and so forth. This coordination between insurance carriers exists to avoid duplicate payment, which could result in a provider receiving payment in excess of the services provided and the total amount billed. <\/span><\/p>\n

Receiving denials due to the coordination of benefits issues is quite common. Whether you are a patient, provider, or billing staff, you surely came across coordination of benefits denial at some point.\u00a0<\/span><\/p>\n

Coordination of Benefits and Medicare<\/span><\/h2>\n

Many patients have Medicare, so it stands to reason that this issue is most commonly seen when dealing with Medicare claims. Medicare-eligible patients may also have a Medicare supplemental plan, such as AARP, as their secondary. <\/span><\/p>\n

In most cases, Medicare will have this information on file and will automatically cross the claim over to the supplemental insurance. However, this process is not foolproof. Therefore, it is important that the provider documents all insurances for the patient. <\/span><\/p>\n

In the event that Medicare does not cross over the claim, providers will need to manually submit claims to the patient\u2019s secondary.\u00a0<\/span>Another common COB denial arises when a patient has recently reached Medicare age but continues to use primary insurance provided by an employer. <\/span><\/p>\n

Often commercial insurances will deny claims until the member updates their COB. In other cases, the carrier will require a denial from Medicare showing that the patient has opted out of Medicare as primary. <\/span><\/p>\n

In both cases, these denials slow down reimbursement<\/a> and cause frustration for the involved parties. Because it is the responsibility of the member to update their COB, amending this problem is often out of the provider\u2019s hands. <\/span><\/p>\n

It is important that patients of Medicare age understand how COB works in order to avoid receiving unnecessary bills from providers.<\/span><\/p>\n

COB and Other Insurance Carriers<\/span><\/h2>\n