Explanation of Benefits (EOB) and Coordination of Benefits (COB)
n
When
an insurer pays for the claim, they need to provide a detailed account of the
expenses that they have paid using a document referred to as the Explanation of
Benefit, EOB. This document is used by Coordination of Benefit, COB,
department.
n
COB
consolidates the collection, management and reporting of insurance claims. This
is done when the member is insured under two or more policies.
·
It can be with Medicare and a normal
policy or from two different policies taken from two different insurance
companies.
·
The purpose of the COB department is to
identify the health benefits available to a member and to coordinate the
payment process to prevent under or over payment.
COB does not process
claims nor does it handle any mistaken payment recoveries or claims specific
inquiries. The Medicare intermediaries and carriers are responsible for
processing claims submitted for primary or secondary payment
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