Changes in COB claims processing will begin with claims submitted on or after December 1, 2015 and will have a limited impact to most providers.
The first of three phases of COB claims processing improvements will simplify COB claim pricing.
All COB claims will be priced in one of three ways:
1. Member Responsibility
The primary payers’ coinsurance, copay, and deductible.
2. Medicaid Allowed Amount Minus Primary Insurance Payment
Medicaid will pay up to our allowed amount.
3. Lesser Of
Medicaid will pay whichever result is less Member Responsibility or Medicaid Allowed Amount Minus Primary Insurance Payment.
In phases two and three we will improve accuracy and timely resolution of COB claims adjudication and decrease claim denials.
For more detailed information regarding these changes, please refer to the Coordination of Benefits Reimbursement Alignment article published in the November 2015 MedicAide.