Coordination of Benefits (COB)
Coordination of Benefits (COB) enables your patients to receive benefits from all health insurance plans they are covered under, while ensuring that the total combined payment from all sources is not more than the total charge for the services provided.

When your patient has coverage under two or more payers, the primary plan will pay benefits first, with secondary and tertiary plans considering any remaining unpaid, eligible balances. When Asuris is the secondary or tertiary plan, you should submit the claim to the primary plan first. When you have received a claims processing voucher from the primary plan, you should submit the claim and a copy of the voucher to Asuris, identifying all insurance coverage information on each claim.

Electronic submission of COB information
Asuris accepts electronic submission of COB claims using standard Health Insurance Portability and Accountability Act (HIPAA), American National Standards Institute (ANSI) formats for both institutional and professional COB claims. This applies to all Asuris products, except Asuris TruAdvantage^TM.

If you are interested in submitting COB claims electronically, please verify with your practice management software vendor that your billing program has the capacity to do so. To ensure the claim is processed correctly, complete all other insurance fields and use the submission guidelines in the Implementation Guide (IG) Registry, including:

• Amount paid
  
• Patient balance
  
• Amount the other carrier approved

If you have questions about submitting electronic COB claims, please contact your software vendor. Vendors or clearinghouses with questions may contact our Electronic Data Interchange (EDI) Support Center at 1 (800) 713-1693.

Additional information about submitting secondary claims electronically is available on the Washington Healthcare Forum website.

Coordination of Benefits (COB) ruling
To comply with a rule issued by the Office of the Insurance Commissioner (OIC), we no longer estimate secondary payer payments if the primary payer’s payment amount is unknown. This rule applies to all employer groups and Individual plans. However, Employee Retirement Income Security Act (ERISA) self-funded groups and Medicare plans are exempt.

For more information, contact your provider consultant.

Maintenance of Benefits (MOB)
Maintenance of Benefits (MOB) lets your patients receive benefits from all payers they are covered under, while maintaining the patient’s responsibility for coinsurance and/or copayment amounts and ensuring that the total combined payment from all sources is never more than the total charge for the services.

With MOB processing, secondary payers only allow benefits up to their own maximum allowable for the specific service(s). If the primary payer’s payment is equal to or greater than what the secondary payer’s payment would have been as primary, no additional benefits will be remitted. This can result in members having out-of-pocket expenses, something not usually seen with COB processing.

Learn more about Benefit Coordination information (PDF).

Note: To print a PDF document, you need Adobe^® Reader^®. Download it now for free.