ABC’s recommended strategy
for addressing COB denials!

Primary reasons for COB denials

1. Payer file contains incomplete or inaccurate COB information.
2. Instead of filing to the primary payer, the claim was filed to the secondary payer first.
3. The explanation of benefits (EOB) denial from the primary payer is absent in the submitted claim.

Steps to handle denied patient claims due to COB

1. Contact the patient regarding the COB update. Initiate the conference call with the patient and insurance.
2. If the patient did not respond, verify with the facility (Ex: Hospital, Dialysis center, etc.) to determine the correct payer.
3. If the patient is from a dialysis center, contact the social worker to notify them about the COB issue.
4. If the patient is unresponsive, contact the patient relation/guarantor.
5. Kindly ask the payer to send the COB letter to the patient and check if they have sent it before, and how many times.
6. If the patient has a future appointment, notify the practice so they can inform the patient while they are in the office and update the COB with the payer.
7. Updating COB allows us to reprocess denied claims.
8. If the new insurance becomes primary after the update, the timely filing requirements of the new insurance must be followed for billing.
9. If any of the above did not work, and the payer information you have is inactive, then bill the payer and save the denial to appeal the original payer.
10. No payer information means we can do nothing without the patient’s involvement.

Case 1: In specific instances, it is possible to get the primary payer information from the portal of the secondary payer. Make sure the primary payer is active for the DOS before submission. If the primary payer is inactive for the DOS, call the patient and insist on updating the COB information with an active payer. If the primary payer information is not available in the secondary payer portal, a simple call to the secondary payer may help to get the primary payer information.

1. After the patient updated the COB with the active payer, refile the claim (Verify COB information by checking insurance eligibility or making an insurance call).
2. If there is no response from the patient with in 2 weeks after insisting on updating the COB, inform the practice and bill the patient immediately.

Case 2: If both the payers denied as “This care may be covered by another payer per coordination of benefits”. Please call the patient and insist on updating the COB information.

1. After the patient updated the COB with the active payer, refile the claim (Verify COB information by checking insurance eligibility or making an insurance call).
2. If there is no response from the patient with in 2 weeks after insisting on updating the COB, inform the practice and bill the patient immediately.

Case 3: If the secondary payer denied the claim as “Missing explanation of benefits”. Fax the primary payer EOB to the secondary payer in order to process the claim.