Coordination of Benefits Reminders for Accurate Claims Processing

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has been focusing our efforts on updating member Coordination of Benefits (COB) information to ensure that members’ claims process correctly where COB is applicable. As part of this ongoing effort, we would like to share a few important reminders with our provider community.

As referenced in our Blue Book Provider e-Manual:

COB refers to how we ensure members receive full benefits and prevent double payment for services when a member has coverage from two (2) or more sources. When there is an indication of additional health insurance coverage, and when COB is legally and contractually permissible, it is the policy of Blue Cross NC to seek to identify the other coverage and to establish the order of benefits prior to adjudicating the claim. This process is known as pursue and pay.

It is important that providers do not submit outdated coordination of benefits information on claims. Submitting inaccurate COB information can result in delays in payment or the inability for Blue Cross NC to process claims. In addition, this could result in duplicate primary payments from multiple carriers, which results in claims adjustments for the carriers, as well as potential bookkeeping issues for you, the provider. Make sure that any other coverage information is accurate on the first submission of the claim. Always make sure that any COB amounts paid by the primary carrier are indicated in the correct fields on the claim form.

To assist with accurate claims processing and prevent duplicate payments, we ask that you confirm with your patients whether they have additional coverage. This practice aligns with the guidelines outlined in the Blue Cross NC Blue Book Provider e-manual.  Thank you for your continued partnership and support.