Provider Central

When a member is injured in an auto accident or on the job, another insurer is often primary. The guidelines below will help you submit these coordination of benefit claims.

Reminder: Third-party liability claims, like other claims requiring attachments, must be mailed. Submit original claim forms. We cannot accept faxes and photocopies for processing.

* Other states’ Blue Cross Blue Shield Plans may have other Personal Injury Protection (PIP) dollar limits.

Notes:

• If a third-party or lump-sum settlement is reached prior to claim submission, claims may not be honored.
• Workers’ compensation insurers’ denials are subject to review by the Third-Party Liability Department to determine if claims will be honored.
• Exemptions from state law:
  • Self-funded accounts
    • Blue Cross has the right to cite exemption from state law for self-funded accounts under the Employee Retirement Income Security Act (ERISA).
    • If the account is self-funded, ERISA may pre-empt state insurance law.
    • The PIP insurer will not be able to rely on standard coordination of benefits.
    • Self-funded accounts process secondary to all automobile PIP and MedPay coverage.
  • Federal Employee Program (FEP)
    • Blue Cross also has the right to cite exemption from state law for FEP members because FEP is governed under the Federal government’s Office of Personnel Management.
    • The contract allows FEP to process secondary to all automobile PIP and MedPay coverage.
    • If a third-party or lump-sum settlement is reached prior to claims submission, claims may not be honored.

If you have questions about billing claims related to other types of accidental injury (for example, dog bites or falls), please contact our Third-Party Liability Department at 1-800-444-6502.