When we are secondary to Medicare or another insurer, submit the claim to the primary insurer first. When you receive the primary insurer’s EOB, send the secondary claim according to instructions.
For claims involving workers’ compensation or auto accidents, refer to our third-party liability information.
|If the primary insurer||You should||By this time|
|Paid the claim or allowed more than $0||Submit the COB claim (see tips below)||Within one year of the date the other insurer processed the claim|
|If the primary insurer||And||You should||By this time|
|Denied the claim or paid/ allowed nothing||You can submit the claim to us within timely filing limits||Submit the COB claim (see tips below)||Within timely filing limits|
|The claim is beyond timely filing limits||Combine your appeal with your claim. Send the following documents to the appropriate appeals address.
Follow standard claim submission guidelines for claims within timely filing limits.
|If your claim is||But||You should||By this time|
|No longer within our timely filing limit||You submitted a claim to another insurer within the timely filing limit and you have an EOB with their denial date||
Combine your appeal with your claim. Send the following documents to the appropriate appeals address.
|If you submit electronic claims this way||Be sure to|
|Web-based tool||Refer to the primary claim and secondary claim instructions in the tool’s user guide|
|Clearinghouse||Confirm with your clearinghouse that COB data entered in your software is transmitted to Blue Cross|
|EDI transaction (Direct Connection)||Review the section, “Coverage Secondary to Medicare or Other Payers,” in our 837 Companion Guide|
Online Services: You cannot submit 1500 claims involving coordination of benefits using the Direct Data Entry tool.
Dental Connect: We do not currently provide claim submission through Dental Connect; however, you can purchase this functionality through Change Healthcare.
Be sure to: