Insurance & Eligibility · Patient Coverage
Coordination of Benefits #
Coordination of benefits determines how multiple coverages work together when more than one policy may be responsible for a claim.
What to do #
- Review every active policy on the patient’s case.
- Confirm which coverage is primary, secondary, and tertiary when applicable.
- Verify subscriber and policy information for each coverage.
- Keep prior-payer payment or adjustment information available when preparing secondary billing.
- Review the case before claim creation.
Verify before you finish #
- Coverage order reflects verified information.
- Each member ID stays with the correct payer.
- Secondary billing is not started before the primary response is understood.
Important
Coordination of benefits is payer-specific. A stored coverage order does not guarantee how a payer will adjudicate a claim.