Add, update, or delete coordination of benefits information

When members and dependents have multiple insurance plans, you need to make sure they're making payments from the correct plans. Managing multiple plans under a single member or dependent is known as coordination of benefits (COB A provision for determining benefits when a member has more than one benefit plan.). See Coordination of benefits (COB) for more detailed information on COB plans.

If you have a claim reference number, a member or dependent name or number, or you received a claim with new or updated COB information, use the Coordination of Benefits tab to view, add, update, or delete information.

Search and open the claim, member, or dependent.
From either the Patient or Claims menu select Coordination of Benefits.

Add a covered dependent for coordination of benefits

On the Coordination of Benefits tab, click below the table.
Update the insurance information and select the coverage from and thru dates.
Select the check box for each individual that has coverage in the Covered Dependents table.
Click to apply your changes.
Click to save.

Update a COB entry

Select the row to update.
Make changes to the COB fields as necessary.
- If you’re offering employer-sponsored health benefits in your workforce, an employee of yours may qualify for what is called “dual insurance coverage” if her/his spouse is also receiving benefits from their respective employer (note: a child may also have dual insurance coverage if covered by both parents’ plans). In such cases, the plan with the oldest policy holder is designated the “primary plan”, while the other is designated the “secondary” plan. The insurance carrier makes this designation, and it isn't selected by the employee making the claim. If needed, update any dependents covered under the same insurance (dual COB).
  Depending on your system, dual COB claims might create automatically for members that have coverage under their dependent’s records as well their own coverage with the same employer.
  You will only be able update the following information if your system administration control settings are configured for dual COB.Contact your basys representative to set or change SAC (System Administration Control) settings. Don't change SACs without first consulting basys as changing them can affect other functions and global system settings.
  1. In the Covered Dependents table, click thein the row to update.
  2. Enter the Secondary ID (SSN) for the secondary claim.
  3. Choose the Secondary Dependent under that SSN (same individual you entered the ID for).
  4. If the claim is being handled manually, clear the Auto-create check box.
  5. Click OK. The information displays in the Covered Dependents table. Note that the secondary dependent's ID number displays, not the name.
Click to apply your changes. The review date and operator name update.
Click to save.

COB Field Descriptions

* indicates a required field

Field	Description
From Date*	The date of the other insurance coverage is in effect. Click and select a date or enter a date in `MM/DD/YYYY` format.
Thru Date	The termination date of the other insurance coverage.
Carrier*	The organization that issued the insurance policy. Select a carrier from the list.
Phone	The carrier's phone number. Enter any alphanumeric or non-alphanumeric characters.
COB Employer	The employer associated with the benefit plan offering. This is a free-form text field to show the employer, but there is no validation on spelling or verification the employer is in the system. This information won’t display anywhere else.
Comments	Additional information associated with the insurance coverage. Any comment text longer than 30 characters will wrap and show in the text box.
Group	The group or employer name. Enter any alphanumeric or non-alphanumeric characters.
Policy	The policy number for the healthcare coverage. Enter any alphanumeric or non-alphanumeric characters.
Plan Type	The claim benefit plan type (e.g. medical, dental or vision).
Level	The insurance plan order to pay the claim. The primary health insurance is the plan that pays the claim first, as if it were the only source of health coverage. Then, the secondary insurance plan picks up the cost left over after the primary plan has paid the claim. `P`—Primary `S`—Secondary `T`—Tertiary
Covered Dependents	The table lists each member of the family. `Name`—The name of the individual. `Relation`—The relationship to the dependent (e.g. Member, Spouse, Child). `Gender`—The individual's gender (M—male, F—female or U—unknown). Select unknown if you don't know the gender. Update the record once you do know. `Date of Birth`—The individual's birth date. `Covered`—A check mark indicates the individual is covered by this insurance policy. You must select at least one individual. Dual COB Primary and secondary coverage claims that are processed by the same fund office. fields (displays based on system configuration) `Second ID`—The policy SSN for the secondary claim. If your system is configured for masking and is turned on, it will be masked. `Sec Depno`—The dependent number of the secondary covered dependent. When you enter the SSN into the `Second ID` field, the `Sec Depno` defaults to that dependent's number. `Auto-create`—Override automatic creation for a secondary claim. The claim will need to be processed manually
Review Information	Text that shows and the date and the operator ID of the person who last reviewed (clicked ), updated, or deleted the COB information.

Delete a COB entry

Select the row to delete.
Click to delete the row from the table.
Click to save.