Process
What is the timeframe in which Cigna can issue COB Survey letter to the member ?
Timeframe within 30 days of their enrollment.
Who can complete COB Survey ?
ANYONE !
What can you make changes to within the survey ? Complete Answer
Patient Relationship (Member, Spouse, Child, Other)
Informants Relationship (Beneficiary, Attorney, Child, Defendant’s Attorney, Employer, Father, Insurer, Mother, Non-Relative, Other-Relative, Provider, Beneficiary other than Attorney, Spouse, Unknown)
Informants First and Last Name
Informants Address (including City and Zip Code)
For PAP and SPAP coverage, if the coverage details are listed, user should ?
Complete answer
User should confirm. If they are not listed, do not add. User should document coverage details in the customer notes.
Mrs. Thompson, a customer since 01/01/2014, calls on 03/01/17 to complete her COB over the phone with an advocate. After verifying PHI, advocate Marsha opens up the COB survey history and verifies the COB data, however, the RX ID number was different. Marsha should:
Edit the coverage to update the RX ID number only.
What is the number and complete name of the Jobaid for COB ?
MS0035 – COORDINATION OF BENEFITS (COB) ANNUAL MAILING
Do a POA or Signature on file has to be on file to complete COB Survey ?
A Power of Attorney form or signature on file is NOT needed to accept and process a COB Survey.
If coverage still exists through a plan that carries prescription coverage, obtain the required information and dates from the customer and ...
What Should You do ?
add /edit it.
For liability information, again confirm if listed or notate account if received. Then .....
Complete answer.
Do not add or edit.
True or False ( If false , Why ? )
If all the data provided on the COB data form matches the information provided by the customer, the information should be deleted since no further update is necessary.
False , Advocate should Confirm .
If a Customer has a Active COB , How many times are the COB Survey sent within Calander Year ?
Once ( Annually ) !
Do the member account has to be fully PHI verified before completing the survey ?
Yes !
What should you do if the customer receives a COB letter, however there is no information listed in the COB survey ?
View the image of the letter (Mail History) and probe the customer to determine:
If coverage still exists
If coverage terminated prior to their enrollment in Cigna-HealthSpring Rx
If coverage was for any type of no-fault/liability situation
If coverage does not cover prescriptions, user should ________ if Listed . If not listed , _________ and just document if received.
Fill in the blanks .
If coverage does not cover prescriptions, user should CONFIRM if Listed . If not listed , DO NOT ADD and just document if received.
Ms. Brador received a letter from Cigna HealthSpring Rx stating that she may have other coverage through XYZ Health Plans. She calls Customer Service and informs the advocate that she has not had this coverage in four years. The advocate verifies her PHI and accesses her COB survey; he sees the coverage through XYZ Health Plans and confirms the information on the line which included a termination date of 12/31/2012. Mrs. Brador joined Cigna HealthSpring Rx effective 01/01/2016.
The advocate should delete the coverage because it terminated prior to the customer joining Cigna HealthSpring Rx.
True or False?
Advocates can update the insurer’s name provided on the COB survey form.
False , You cannot update “insurer name” so do not change)
Can a Daughter complete COB Survey for disabled mother ? ( Without POA , Legal Authorization ) on file .
YES !
As long as the caller verifies PHI, any third party signature on behalf of the customer is acceptable without further validation.
How would you Disposition the COB Survey ?
WHEN WE RECEIVE A BLANK COB QUEUE, NO IMAGE ON COB QUEUE OR IMAGE HISTORY AND THE CUSTOMER STATES THAT THEY DO NOT HAVE ANY ADDITIONAL INSURANCE.
NO ACTION NO COB DATA
What would u do if member call about duplication Letters ?
Apologize to caller for the duplicate mailing
Verify if COB survey has been completed
o If yes: Advise caller that the survey is completed and no additional information is required. [Note: Be sure to update the survey if required missing fields are blank.]
o If No: Offer to complete electronic survey with the caller over the phone. If declined, let them know that they can complete the survey and mail it back to us using the return address on the letter.
Answer any additional questions using appropriate reference tools
Mr. Thal was completing his COB survey with advocate Adam on the phone and realize that in addition to the coverage that he has, he has a SPAP that helps with his drug coverage and that he would like to provide that information. After reviewing the account, the advocate notice that the coverage detail for the SPAP is not listed on the account. The advocate should:
Do not add the coverage, however, document coverage details in the customer notes.
Additional:
Advise the customer to contact the SPAP to ensure coverage since the SPAP coverage detail is not listed on the account.
True or False :
Is the electronic signature date is the indicator of completion of the survey ?
True.The electronic signature date is the indicator of completion.
What information does third party needs in order to complete the COB Survey ?
ID card issued by the other insurance carrier so that they are able to accurately obtain the name, phone number, Rx ID, Rx Bin, Rx PCN and effective date of other coverage.
If coverage was for any type of no-fault/liability situation (car insurance/home insurance etc.), customer is to contact the insurance company and request that the information be provided directly to
to WHO ?
CMS !
IMPORTANT: These customers will receive a survey for each sequence of coverage received from the Coordination of Benefits Contractor (COBC). When reviewing these accounts, you will notice in the CHS COB survey queue in the PDP system a line of coverage for each sequence and .....
What should you do ?
You must confirm each one. Once the change to the data file is made to exclude the duplicates, you will still see and have to verify each line of coverage regardless of what the customer actually received on paper.
Advocate Samantha receives a call in which a customer receives a COB letter however there is no information listed in the COB survey queue. Samantha views the image of the letter in the Mail History and probe the customer and determined that the coverage was for a type of no fault/liability car insurance. The advocate should:
A.Do not add the coverage, however, document coverage details in the customer notes.
B.Advise customer to contact the insurance company and request that the information be provided directly to Medicare
C.Add the coverage since the customer confirms it exist.
D.Both A and B