Coordination of Benefits (COB)
Coordination of Benefits (COB) enables your patients to receive benefits from all health insurance plans they are covered under, while ensuring that the total combined payment from all sources is not more than the total charge for the services provided.

When your patient has coverage under two or more payers, the primary plan will pay benefits first, with secondary and tertiary plans considering any remaining unpaid, eligible balances. When Regence or Regence Life and Health is the secondary or tertiary plan, you should submit the claim to the primary plan first. When you have received a claims processing voucher from the primary plan, you should submit the claim and a copy of the voucher to Regence, identifying all insurance coverage information on each claim.

When Regence is in the secondary responsibility the following will apply:

• We will not pay more than an amount which, when added to amounts received from other coverage(s), equals 100% of the total allowable expense as defined by OAR 836-020-0775.
• If a Member Agreement is not subject to OAR 836-020-0770 through OAR 836-020-0805, we will calculate our payment when in the secondary responsibility in accordance with the terms of the Member Agreement or other applicable law.
• Unless otherwise required by law, the physician, health care professional or facility agree to accept the negotiated amount as payment in full, whether that amount is paid in whole or in part by the member, or by Regence, or by any combination of payors, including other payors which may pay before Regence in the order of benefit determination.
• Regence will never pay more than we would have paid in the absence of other coverage.

Note: This COB provision does not apply to Oregon-based employer groups that use Maintenance of Benefits (MOB) instead of COB or to Oregon-based Individual plans that do not contain a COB provision.

Electronic submission of COB information
Regence accepts electronic submission of COB claims using standard Health Insurance Portability and Accountability Act (HIPAA), American National Standards Institute (ANSI) formats for both institutional and professional COB claims. This applies to all Regence products, including the Federal Employee Program (FEP) with the exception of Regence MedAdvantage.

If you are interested in submitting COB claims electronically, please verify with your practice management software vendor that your billing program has the capacity to do so. To ensure the claim is processed correctly, complete all other insurance fields and use the submission guidelines in the Implementation Guide (IG) Registry, including:

• Amount paid
  
• Patient balance
  
• Amount the other carrier approved

If you have questions about submitting electronic COB claims, please contact your software vendor. Vendors or clearinghouses with questions may contact our Electronic Data Interchange (EDI) Support Center at 1 (800) 713-1693.

Maintenance of Benefits (MOB)
Maintenance of Benefits (MOB) lets your patients receive benefits from all payers they are covered under, while maintaining the patient’s responsibility for coinsurance and/or copayment amounts and ensuring that the total combined payment from all sources is never more than the total charge for the services.

With MOB processing, secondary payers only allow benefits up to their own maximum allowable for the specific service(s). If the primary payer’s payment is equal to or greater than what the secondary payer’s payment would have been as primary, no additional benefits will be remitted. This can result in members having out-of-pocket expenses, something not usually seen with COB processing.

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