Insurance Verification and COB
Verifying insurance before rendering services is crucial for avoiding claim denials and ensuring appropriate payment. Verification confirms that the patient’s coverage is active, identifies any referral or authorization requirements, and determines the patient’s deductible, copay, and coinsurance responsibilities.
Coordination of Benefits (COB)
When a patient has more than one insurance policy, Coordination of Benefits rules determine which payer is primary. Common COB scenarios include:
- Patients with coverage through both their own employer and a spouse’s employer
- Children covered under both parents’ plans
- Medicare beneficiaries with supplemental coverage
Proper COB processing ensures that claims are submitted to the primary insurance first, with secondary claims filed after the primary payment is received. This prevents overpayment and ensures that the total payments from all sources don’t exceed the provider’s charges or the allowed amounts.