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