Wiki "Not payable due to coordination of benefits"

[nanaks]

Please help me to understand this.

We bill Medicare and many patients have secondary. My question is below.

Example: BlueCross EOB says
"This amount is not payable due to coordination of benefits with the member's other carrier. "

In this case, can we bill patients (Medicare allowed amount) or is this mean that this claim was denied by BlueCross?

Thank you!

 

[CodingKing]

I believe when blue cross says that it means the primary carrier paid more than you are owed thus Medicares payment is considered payment in full

 

[talton0206]

You could drop it to the patient but it's not really in anyone's best interest. If the patient is Medicare eligible, primary or secondary, you should start with an MSP questionaire.

If it is a BC Federal patient and the patient only has Part A, that's an entirely different beast.

If you have access to online verification of BC you can usually tell if they have sent out a COB questionaire to the patient that has never been returned.

That denial could mean a multitude of things, the only way you'll know for sure is to pick up the phone and call the payer and ask, then call the patient and give them instructions to call their payer(s) and get it straightened out.

We only balanced billed the patient as a last resort because it's generally a lack of understanding on the patient's part, not negligence.

Good Luck

 

[hopepg]

Review all the remark codes on the BCBS EOB. Sometimes there are other remarks which will explain the non payment more in detail.
Also look in the "patient share" or "copay/coinsurance/deductible" columns on the BCBS EOB. If it lists a patient responsibility, then billing the patient that amount would be acceptable.
If still unsure, call or check for more detail on their website.
Good luck!