Coordination of Benefits (COB)
The purpose of Coordination of Benefits (COB) is to identify patients who are covered by more than one health insurance plan.
Why is this important? Medicaid can only be paid if the primary insurance is exhausted first. For example:
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If this happens:
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You should do this:
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If I’m not sure the patient has more than one health insurance plan….
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Simply ask! Ask the patient for their ID cards. Providers should verify the patient’s insurance coverage at the time of service.
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If I find out the patient has more than one health insurance plan….
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Bill the patient’s primary first before seeking reimbursement from Medicaid or Medicare Managed Care Plans.
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If I submit a claim to CareSource without an Explanation of Benefits and the member has other coverage….
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The claim to CareSoure will be denied if the patient has primary health insurance, which must be exhausted first. CareSource confirms that members do not have coverage through another carrier to ensure that claims are paid by the appropriate payer.
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If I submit a claim, the timely filing guidelines…
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Are as follows:
· 365 days from the Date of Service, OR
· 90 days from the date of the primary insurance’s Explanation of Benefits date, whichever is greater.
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Please see the Frequently Asked Questions section for more information on Coordination of Benefits.
Workers' compensation
All claims indicating that a Member's diagnosis was caused by the member's employment will not be paid. The provider will be advised to submit the charges to Bureau of Workers' and Unemployment Disability Compensation for reimbursement.
Automobile insurance
Under Michigan's "no fault" law, automobile insurance carriers are required to pay the medical expenses for injuries incurred in an automobile accident. However, in some instances, the automobile policy contains a rider stating that health insurance coverage takes priority over automobile insurance.
Providers may pursue "no fault" claims directly with the automobile insurance carrier. Providers may also bill CareSource while the automobile insurance claim is pending. CareSource must be billed within six months from the date the "no fault" claim was filed. CareSource then pursues reimbursement from the other insurance carrier through subrogation.
For more information, please see the Provider Manual.