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Coordination of Benefits (COB)


Provider Administrative Policy

Section
Claims Submission
Policy Date
February 2008
Status/Date
Revised/May 2013
Provider Type(s)
All Providers  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.

Policy

Coordination of Benefits (COB)

For Blue Cross of Idaho to apply benefits correctly, we need to know if a member has other health coverage. To help reduce the number of denied claims for coordination of benefits (COB), we send the member a letter asking for information about other insurance one month prior to the expiration of current COB information.

If you are aware of other insurance information for any Blue Cross of Idaho members, please supply the information to Blue Cross of Idaho on your claim forms. On claim form CMS1500, please include this information in field 11d and if the answer is 'yes,' complete fields 9a and 9b. On form UB04 enter the COB information in fields 50-62.

The COB questionnaire and online form is available on the secure provider portal on the Blue Cross of Idaho Web site at bcidaho.com. Select Provider, then Forms, then Coordination of Benefits Tools, and choose the printable form to complete and fax in or the online form to complete and submit electronically. We have provided a fax transmittal form to fax with the hard copy verification insurance information.

Coordination of Benefits (COB) Form

We will reprocess any claims denied for coordination of benefit information when we receive other insurance information establishing Blue Cross of Idaho as the primary carrier. If we receive information establishing Blue Cross of Idaho is secondary, we will not reprocess claims until we receive the primary payment information. You may submit COB secondary claims electronically only if you have checked with your Practice Management software vendor to ensure they are capable of sending this information. The submission must include the following:

  • COB Type
  • COB Amount (amount paid by primary carrier - by total claim or by claim line)
  • COB Allowance (amount allowed by primary carrier - by total claim or by claim line)
  • COB Deductible (the total amount the primary carrier applied to the member's deductible- by total claim or by claim line)
  • COB Copay (total copay applied by the primary carrier - by total claim or by claim line)
  • COB Coinsurance (total coinsurance applied by the primary carrier - by claim total or by claim line )
  • COB Member Liability (member liability after primary payment - by total claim or by claim line)

Note:  If the electronic submission is missing any of the above criteria, we may deny the claim and request a hard copy of the remittance advice from the primary insurance. 

 

Primary carrier payment/remit:

Billed

Primary Allowed

Primary Deductible

Primary Coinsurance

Primary Paid

Contractual Adjustment

$1,000.00

$700.00

$100.00

$120.00

$480.00

$300.00 

Blue Cross of Idaho new COB legislation secondary payment/remit:

Billed

Blue Cross Deductible

Blue Cross Coinsurance

Blue Cross Copay

Non Covered 

Other Carrier Paid

Contractual Adjustment

Blue Cross Paid

$1,000.00

Met

$0.00

$0.00

$0.00

$480.00

$300.00

$220.00

Please note on the example above, we determined the secondary payment of $220.00 by adding the total of primary deductible ($100.00) and primary coinsurance ($120.00).

When contracting providers bill Blue Cross of Idaho as a secondary payer, they are obligated to take contractual adjustments up to what they would have taken if Blue Cross of Idaho were the primary payer. 

Blue Cross of Idaho will base non-contracting provider COB reimbursements on the higher of the primary or Blue Cross of Idaho allowance.

For providers receiving a HIPAA electronic 835 remittance advice, Blue Cross of Idaho will append the claim adjustment reason code 23 to reflect the payment adjustment is due to the impact of the prior payer(s) adjudication. For paper remittances, Blue Cross will append 526, 209 or 8N3 based on how we received the other carrier's information.

Because of the various member and provider contract terms across different payers, it is impossible to outline every possible example. Please contact your provider relations representative if you have any questions.

 


Policy History

Date Action Reason
May 2013 Revised Removed reference to the 835 Companion Guide
October 2011 Revised Language revision
April 2010 Revised Updated COB electronic information
May 2008 Revised Language clarification

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