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Medical Policy, Clinical UM Guidelines, and Pre-Cert Requirements

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Coordination of Benefits (COB)

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Coordination of Benefits (COB) refers to how we ensure members receive full benefits and prevent double payment for services when a member has coverage from two or more sources. The member’s contract language explains the order for which entity has primary responsibility for payment and which entity has secondary responsibility for payment. 
If you discover the member is covered by more that one health plan, and: 
BCBSGa or any other Blue Plan is the primary payer, submit the other carrier’s name and address with the claim to BCBSGa. If you do not include the COB information with the claim, the member’s Blue Plan will have to investigate the claim. This investigation could delay your payment or result in a post-payment adjustment, which will increase your volume of bookkeeping.
Other non-Blue health plan is primary and BCBSGa or any other Blue Plan is secondary, submit the claim to BCBSGa only after receiving payment from the primary payor, including the explanation of payment from the primary carrier. If you do not include the COB information with the claim, the member’s Blue Plan will have to investigate the claim. This investigation could delay your payment or result in a post-payment adjustment, which will increase your volume of bookkeeping.
 
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Blue Cross and Blue Shield of Georgia, Inc. and Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.