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.
Refer to our billing guidelines or 837 Companion Guide for field/data requirements. Additional tips for COB claims appear below.
For claims involving workers’ compensation or auto accidents, refer to our third-party liability information.
When we are not the primary insurer
| 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.
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When we are primary
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.
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Tips for electronic COB claims
- You must report:
- The primary insurer’s name and address
- And the insured member’s ID number
- If the other insurer paid, report the amount paid by the other insurer at the claim’s line level.
- If the claim was denied by the primary insurer, report the reject reason.
Dentists:
- Do not attach Pre-Treatment Estimates when submitting your COB claim. Only EOBs are accepted.
- Please provide all required information in your claim. Including the Vyne Dental number is helpful, but not required. (Vyne Dental was formerly National Electronic Attachment, or NEA.)
Methods for submitting electronic COB claims
| 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 |
ConnectCenter: At this time, 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.
Tips for paper COB claims
Be sure to:
- Enter the other insurer’s information on your claim form as required in our billing guidelines
- Mail the claim form with the other insurer’s EOB attached.
