Coordination of benefits or COB

What is coordination of benefits or COB?

The order in which two or more insurance companies will pay benefits for the same claim. This will avoid duplicate payment of the claim by more than one insurance.

How to handle coordination of benefits in CH ?

Handling COB in the clearinghouse where the data flow model is from Provider-Payer A-Provider (CH behalf of provider) -Payer B is clearly explained to the segment level, pls follow the excerpt from 837 IG

Coordination of Benefits Data Models - Detail
The 837 transaction handles two models of coordinating benefits. Both models
are discussed in Section 1.4.2.2, Coordination of Benefits Data Models. See Section
4, EDI Transmission Examples for Different Business Uses, for examples of
these models. The implementation guide contains notes on each COB-related
data element specifying when it is used. See the Federal Register for HIPAA
rules involving COB.
Model 1 - Provider-to-Payer-to-Provider
Step 1. In model 1, the provider originates the transaction and sends the claim information
to Payer A, the primary payer. See figure 1, Provider-to-Payer-to-
Provider COB Model. The Subscriber loop (Loop ID-2000B) contains information
about the person who holds the policy with Payer A. Loop ID-2320 contains information
about Payer B and the subscriber who holds the policy with Payer B. In
this model, the primary payer adjudicates the claim and sends an electronic remittance
advice (RA) transaction (835) back to the provider. The 835 contains the
claim adjustment reason codes that applies to that specific claim. The claim adjustment
reason codes detail what was adjusted and why.
Step 2. Upon receipt of the 835, the provider sends a second health care claim
transaction (837) to Payer B, the secondary payer. The Subscriber loop (Loop
ID-2000B) now contains information about the subscriber who holds the policy


from Payer B. The information about the subscriber for Payer A is now placed in
Loop ID-2320. Any total amounts paid at the claim level go in the AMT segment
in Loop ID-2300. Any claim level adjustments codes are retrieved from the 835
from Payer A and put in the CAS (Claims Adjustment) segment in Loop ID-2300.
Claim level amounts are placed in the AMT at the Loop ID 2320 level. Line Level
adjustment reason codes are retrieved similarly from the 835 and go in the CAS
segment in the 2430 loop. Payer B adjudicates the claim and sends the provider
an electronic remittance advice.
Step 3. If there are additional payers (not shown in figure 1, Provider-to-
Payer-to-Provider COB Model), step 2 is repeated with the Subscriber loop
(Loop ID-2000B) having information about the subscriber who holds the policy
from Payer C, the tertiary payer. COB information specific to Payer B is included
by running the Loop ID-2320 again and specifying the payer as secondary, and, if
necessary, by running Loop ID-2430 again for any line level adjudications.

And the next method given in the IG can be ignored as of now as it is about crossover of the payer.

Lets see which are the segments to be considered in 835 for COB, following is the excerpt from 835 IG

CROSSOVER CARRIER NAME
Loop: 2100 - CLAIM PAYMENT INFORMATION
Usage: SITUATIONAL
Repeat: 1
1724 Notes: 1. Use this NM1 segment to provide information about the crossover
carrier. Provide any reference numbers in NM109. The crossover
carrier is defined as any payer to which the claim is transferred for
further payment after being finalized by the current payer.
1636 Example: NM1*TT*2*ACME INSURANCE*****XV*123456789~



in the above example ACME ins is the next payer to which the claim has to be sent according to COB order.

And page 114-118 of 835 IG will give you all necessary description and detail about COB.

any more clarification pls revert.