COB Terms
Letters
Credit Clues
COB Rules
Payer Portals
100
What is, a state and federally funded program for low-income individuals that always pays last in COB?
What is, Medicaid
100
What is, the letter used to refund only one of the payment or transaction?
What is, Automated Refund Letter
100
Whose plan is first?
A claim is submitted for Victor Weasley (DOB: 8/10/2014). He is listed as a dependent of Hermione Weasley (DOB: 9/26/1990). In EPIC, he is also listed as a dependent of Ron Weasley (DOB: 11/12/1989)
Who is, Hermione Weasley
100
What is the Medicaid Rule?
What is, Medicaid is always the payer of last resort
100
What is, the portal used for payers such as BCBS, Aetna, Healthfirst?
What is, Availity
200
What is, a federal health insurance program primarily for individuals 65+ or with certain disabilities?
What is, Medicare
200
What is, the letter used to advise payers to retract an overpayment?
What is, Request to Recoup/Offset Letter
200
What are, two backups that are mandatory for both the refund and recoup/offset letters for COB overpayment?
What are, Eligibility and EOB screenshots
200
What is the Newborn Rule?
What is, for the first month of life, the mother's insurance is primary
200
What is, the portal used for Medicare?
What is, Connex
300
What is, the electronic or paper explanation sent by an insurance company that tells you how a claim was processed and paid?
What is, Remit (Remittance Advice)
300
What is, the letter used to refund multiple payments or transactions?
What is, Manual Refund Letter
300
What is, DOB (Date of Birth) importance for COB?
What is, DOB is used to help determine coverage priority (especially for the Birthday Rule and Retiree/Medicare rule).
300
What is the Birthday rule?
What is, the primary will be whichever parent's birth month/day falls first in the calendar year
300
What is the portal used for Medicaid?
What is, ePaces
400
What is, an Epic tool used to electronically verify a patient's insurance coverage directly with the payer while you are viewing the account?
What is, RTE (Real-Time Eligibility)
400
What is, the letter used to inform patient of issues in the order in which insurance plans should pay when due to more than one policy & to update info?
What is, COB Letter
400
What is, this adjustment code tells providers that the secondary payer was aware of and valued the primary payer's payment when processing the claim?
What is OA-23
400
What is the Eligibility/Effective Date Rule?
What is, the plan that covered the member longer is Primary
400
What is the portal used for New York City Employees PPO (NYCE)?
What is, Emblem Health/UHC for New York City Employees PPO (NYCE)
500
What is, the coverage that allows employees and their families to continue their group health insurance coverage for a limited time after a qualifying event, such as job loss?
What is, COBRA (Consolidated Omnibus Budget Reconciliation Act)
500
What is, the 4 mandatory sections that need to be filled out for the Automated Refund Letter under the Additional Information field of the Refund Screen in EPIC?
What is, Original Claim Amount, ICN/Claim Number, CPT Code, Y/N for attachment
500
Failing to set COB correctly can result in this common billing issue?
What is, claim denial or delay in payment, or overlap
500
What is the VA Community Plan Rule?
What is, VA will be primary (VA Community does not coordinate with other payers)
500
What is, the portal used for Local 1199?
What is, Navinet (As this is for 500, OneSource will also suffice)