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.
|If you’re submitting a claim for a member who has related:||You can bill us for any outstanding balance after:||Be sure to:|
|Auto insurance||The auto insurer:
|Workers’ compensation insurance||The workers’ compensation insurer has:
* Other states’ Blue Cross Blue Shield Plans may have other Personal Injury Protection (PIP) dollar limits.
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.
|How to appeal a third-party liability claim involving a Massachusetts member
If we reject your claim because of an error in the claim, follow the replacement claim process. However, if your third-party liability claim involves a Massachusetts member and you disagree with the third-party liability denial, fax a Request for Claim Review Form and any required documents to our Third-Party Liability Department at 1-617-246-9967.
BlueCard (out-of-state) third-party liability appeals should be mailed to the claims address for Professional or Institutional claims.