10/21/2009
New COB rules impact payment order, contract language
Health carriers in Washington often make changes to their policies and contracts in order to comply with legislation or rulings made by the state's Office of the Insurance Commissioner.
Currently there are two major revisions. These changes will affect the way that health plans in Washington process claims as the secondary payer.
The secondary payer will no longer need to estimate claim payment if the primary payer has not paid. In addition, the secondary payer will pay the primary if the claim is resubmitted with notification that the primary carrier has not made payment within 60 days of receipt of the claim.
We have updated our 2009 Coordination of Benefits (COB) language to reflect these changes for dates of service on or after Sept. 1, 2009. As a result, we are required to provide our members with a summary of the benefit booklet changes that have occurred. This notification must occur by Jan. 1, 2010.
To that end, the following information will be communicated to all our groups (except self-funded groups) the week of Oct. 26:
If you have any questions, please talk to your Asuris Sales contact.
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