COORDINATION OF BENEFITS PROCESS

When a practitioner submits the first claim of the year for a CIGNA Health Solutions participant (whether a new or an established patient), the Health Solutions claims department will process the claim and then send a letter and Coordination of Benefits form to the participant to determine if they have any other insurance coverage. . Should Health Solutions receive information that a participant is eligible for benefit under more than one plan, we will determine which benefit plan pays first, or is “primary”, before claims are processed for payment. This process is commonly known as coordination of benefits (“COB”).

As a practioner, it is vitally important to us that you are paid correctly and in a timely manner. One of the things you can do to assure this occurs consistently is to verify, at the time of your office intake, if a participant may be eligible for benefit under more than one plan. Here are some common scenarios in which a participant may have multiple insurance coverage:

• Both a plan subscriber and his/her spouse are employed and carry health insurance.
• The identified participant is a dependent child of divorced parents who both carry insurance.
• The participant has two employers and carries health insurance through both employers.
• The participant has retired and is eligible both for retiree coverage through his/her employer as well as through Medicare.
• The participant is covered both as a retiree under a group plan as well as an active employee under another insurance plan.

We hope this gives you a general idea of the frequency with which COB issues arise and how you can troubleshoot them to prevent delays in claims payment.

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