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Coordination of Benefits

We encourage providers to submit Coordination of Benefits (COB) claims electronically. COB claims can be processed more efficiently by directly submitting from: 

  • A provider who has received a remittance advice from the previous payer (provider-to-payer COB).
  • The previous payer (payer-to-payer COB).

Tips for Submitting Coordination of Benefits Claims
In order to submit COB claims, your practice management system, data entry portal or clearinghouse must be able to:

  • Create or forward claims in full HIPAA standard format (837) or in a format that contains equivalent information and includes necessary COB fields.
  • Include electronic payment information received from the primary payer's HIPAA standard electronic remittance advice (ERA).

OR

  • Include electronic payment information by converting the primary payer's paper Explanation of Benefits (EOB) into HIPAA standard coding used in an ERA.

Resource Guides
These guides contain more details about COB-related information:

  • 5010 Professional and Institutional 837 Implementation Guides (section 1.4.1, pages 3-26), available from the Washington Publishing Company.
  • WellCare Companion Guides.
  • COB Balancing Claim Level and Line Sections are located:
    • 837 Professional IG – Claim Level pages 299–304 and Line Level pages 484–489
    • 837 Institutional IG – Claim Level pages 358–363 and Line Level pages 480–485

For claims filing and EDI-related issues, please email WellCare's EDI Department.

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Last Updated On: 11/9/2016