Coordination of Benefits (COB)
HealthChoice has modified its Coordination of Benefits guidelines for claims processed on or after March 3, 2011.
With the exception of claims when the primary insurance carrier pays zero, HealthChoice pays the remaining balance on covered charges after the primary carrier payment.
When the primary carrier pays zero, HealthChoice Allowed Charges, plan deductibles, copays and coinsurance apply for allowed benefits.
Regardless of the primary carrier’s payment, HealthChoice must deny claims for non-covered services and services that exceed plan limits. Plan provisions apply.
An unofficial copy of the OSEEGIB Agency Rules, which include the COB Rules, is available from the OSEEGIB Provider Relations Division.