How do coordination of benefits (COB) and electronic remittance advice (ERA) interact when a secondary payer processes a claim?

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Coordination of benefits hinges on the secondary payer using the primary payer’s adjudication to determine what remains payable. The secondary plan reviews the primary payer’s electronic remittance advice (ERA) or paper explanation of benefits (EOB), which shows what the primary paid, what was denied, and the patient’s remaining responsibility. With that information, the secondary payer applies its own benefits rules, may adjust or pay the leftover amount, and considers the patient’s deductible, coinsurance, and any secondary plan limitations.

It’s essential that the secondary claim is submitted in the correct sequence after the primary adjudication and within required timeframes. The secondary payer does not simply deny or ignore the primary payment, nor does it automatically pay the full amount regardless of what the primary has paid.