Coordination of Benefits

We encourage providers to submit Coordination of Benefits (COB) claims electronically. COB claims can be processed more efficiently by directly submitting from:

• A provider who has received a remittance advice from the previous payer (provider-to-payer COB).
• The previous payer (payer-to-payer COB).

Tips for Submitting Coordination of Benefits Claims

In order to submit COB claims, your practice management system, data entry portal or clearinghouse must be able to:

• Create or forward claims in full HIPAA standard format (837) or in a format that contains equivalent information and includes necessary COB fields.
• Include electronic payment information received from the primary payer's HIPAA standard electronic remittance advice (ERA).

Resource Guides

These guides contain more details about COB-related information:

• 5010 Professional and Institutional 837 Implementation Guides (section 1.4.1, pages 3-26), available from the Washington Publishing Company.
• WellCare Companion Guides.
• COB Balancing Claim Level and Line Sections are located:
  • 837 Professional IG – Claim Level pages 299–304 and Line Level pages 484–489
  • 837 Institutional IG – Claim Level pages 358–363 and Line Level pages 480–485