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Coordination of benefits policy for group claims: spouses and dependent children

Effective March 1, 2005, BCBSNC will institute a new coordination of benefits policy for the processing of group claims for spouses and dependent children.

Under the new policy, when BCBSNC receives a group claim for a spouse or dependent child of a BCBSNC subscriber showing other coverage, but we have not received or do not have in our record sufficient information to determine liability, we will deny the claim and request additional information. We will reopen the claim when the requested information pertaining to the other coverage is received, within 18 months of the date of service, or one year from the date of denial, whichever is later.

Coordination of benefits is not applicable when the other insurance covering a patient is a student accident policy or a nongroup individual policy. When the other coverage is one of these policy types, please note this information in the "other insurance policy" field on the claim in order to ensure accurate processing.

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