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Update: Coordination of benefits claims submission and processing requirements

BCBSNC would like to remind our providers that we follow the provider–payor–provider model for coordination of benefits.

When two or more carriers, including Medicare, administer benefits for a patient, the provider should initially submit a claim only to the primary carrier. The claim submitted to the primary carrier should include:

  • The name of the secondary carrier
  • The name and relationship to the patient (or birth date and sex) of the secondary policy holder

Please do not file a claim with the secondary carrier until the primary carrier has completed processing the claim and has reported the results to you.

When submitting claims electronically, be sure to include the primary carrier’s payment information on the secondary claim. For paper claims, please submit a copy of the primary carrier’s Explanation of Payment (EOP) with the secondary claim.

If you have any questions, please contact your local Network Management office.