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Birthday Rule/Dependent

  1. #1
    Default Birthday Rule/Dependent
    Medical Coding Books
    I have a question, we have a patient who has Cigna and BCBS. Cigna paid as primary and then turned around and requested a refund for other insurance primary. We then verified BCBS was primary but according to the birthday rule the patients wife is the subscriber with Cigna and therfore would make Cigna primary. Then we were told by Cigna that since he is the subscriber with BCBS and not a dependent, Cigna would be secondary. Does this supersede the birthday rule???

  2. #2
    I know someone will correct me if I am wrong, but it is my understanding that the birthday rule only applies to dependent children - not spouses. If the patient is the subscriber on the insurance, it is primary and he or she is a dependent on the spouse's policy and vice versa, regardless of birthday.

  3. #3
    Hartford, CT
    Greatbiller is correct, the birthday rule does not apply to spouses. If the husband is the subscriber for BCBS and the wife is the subscriber for Cigna, then BCBS is primary for the husband with Cigna secondary; Cigna is primary for the wife with BCBS secondary.

    You can usually find out how each insurance carrier handles this on their webistes in the provider or administrative manuals.
    Doreen Clark, CPC, CPMA
    Medical Auditing Specialist
    Integrated Physicians Management Services
    East Harftord. Ct

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