Who's On First?
A claim was submitted to DDCO for Monica. Monica works for Maggiano's and carries dental coverage for her and her spouse. Chandler is listed as Monica's spouse on the view input. He works for Bing Advertising and carries dental coverage for him and his spouse.
Who is Monica?
This insurance plan might be correctly linked to a member for certain groups that will not require a COB record to be built.
What is DeltaVision? Or What is an individual group?
This document must accompany a claim when DDCO is secondary.
What is an EOB?
Other than the audit log, this is another location to add information about where you found how to build the COB record, how you determined priority, and is a requirement of building or modifying a COB record.
What is the COB Record notes?
A claim is submitted to DDCO for Jack Bing (DOB: 8/10/2014). He is listed as a dependent of Monica Bing (DOB: 9/26/1990). In the view input section, he is also listed as a dependent of Chandler Bing (DOB: 11/12/1989).
Who is Monica?
When a claim triggers for possible COB coordination, this additional information could be checked besides name and date of birth to verify they are the same person.
What is address? What is the employer? What are the dependents? What is an SSN?
These are all the things you may need to enter on the COB tab from a primary EOB with external carriers.
What is the paid amount, allowed amount, member responsibility, paid amount, and co-pay or deductible if applicable?
This COB record effective date is used when the DOS and DDCO's effective date's years do not match.
What is January 1, Same Year as DOS?
The primary policyholder for this claim is submitted to DDCO for Judy Geller (DOB: 3/13/1961). Judy is the subscriber to the DDCO policy and carries coverage for herself and her spouse Jack Geller (DOB: 6/25/1966). In the view input and in remarks, Jack Geller’s plan is listed as secondary to Judy’s policy. Further review displays Judy’s policy as a COBRA plan.
Who is Jack Geller?
After processing a primary delta-on-delta claim, this step must happen to complete the process.
What is chasing the secondary claim? What is processing the secondary claim?
This formula can help you to determine the member responsibility if an EOB does not display it.
What is the allowed amount – the paid amount? Or What is the allowed amount - paid amount + deductible/copay?
This date is used as the effective date of the COB record when the DOS and the DDCO effective date's years match and the DDCO effective date is after January 1st of the same year.
What is Same Month, Same Year as DOS?
The primary policyholder for this claim is submitted for Ben Geller (DOB: 3/3/2012). Ross Geller (DOB: 5/30/1986) has family coverage in which Ben is listed as a dependent child. In view input, Ben is also listed as a dependent of Carol Willick (DOB: 4/20/1987) who has Metlife coverage. In the remarks section, there is a note stating, "Carol is mom, custody split 50/50 with dad. Susan Bunch (DOB: 2/11/1984) also carries coverage for Ben Geller as a stepparent."
Who is Carol Willick?
This is the other insurer’s effective date on the COB record when they have not supplied one to us, if the DDCO effective date is July 1, 2023, and the DOS on the claim is January 24, 2024.
What is January 1, 2024?
This is what we call the difference between the billed amount and the allowed amount.
What is the [provider] write off? What is the provider adjustment?
These items are the additional things or differences you need to add to a COB record when both plans are with DDCO.
What is the company name as the group name, the effective date as the later defective date between the two policies, and other insurer id’s (IT Type, ID number/member ID and effective date – through date)?
The primary policyholder for this claim is submitted to DDCO for Phoebe Buffay. Phoebe’s name also populates in the view input with another DDCO insurance. The first DDCO plan effective date displays as 1/1/2021 – 1/1/3000. The second DDCO plan effective date displays as 1/1/2020. In the second plan’s benefit plan tab, it displays two effective dates, one being 1/1/2020 – 12/31/2022, and the other date being 4/1/2023 – 1/1/3000. The date of service is 6/20/2023.
What is the first DDCO plan? Or What is the plan with the 1/1/2021 effective date?
This is the other insurer’s effective date on the COB record when they have not supplied one to us, if the DDCO effective date is March 1, 2024, and the DOS on the claim is April 13, 2024.
What is April 1, 2024?
This is the provision that says when the primary paid more than what the secondary plan would have paid, there is no additional benefit payable. This provision can be found in the benefit plan details.
What is non-duplication of benefits?
The primary policyholder for this claim is submitted to DDCO for Rory Gilmore. She is the subscriber to an account called Tumbleweed Reporting. In the view input, other insurance information, you see the member’s name is also Rory Gilmore and the plan is Humana. You check the effective dates, and they are both 1/1/2023.
What is – there is no primary? What is this is a 50/50 COB?