Coordination of Benefits

Updated 1 year ago by Melissa Albright

Explore how COB works in RxWeb using the COB Calculator.
If the Type is set to a value other than blank, the COB feature is used. The only option for the primary insurance is Current. Non primary insurances can also be set to 'Remainder From Primary', 'Remainder From Current', 'Remainder From Bill', and 'Remainder From Retail'.
Non primary insurances can also specify a billing multiplier to use if the allowable is MSRP times billing multiplier. The default billing multiplier is set from the billing multiplier set for the insurance in Rx Admin.
Additional fields are provided in the Payer Edit for amount paid by the insurance, the check number the insurance company paid with, the contact name and phone at the insurance company for this order, and the policy and group numbers.
To specify the patients responsibility, create an insurance named Patient Responsibility with a plan name of Cash.  Set the plan to Retail Minus at 0%.  Set this insurance and plan as the last insurance on the order, and set the COB type as appropriate and set the COB percent to 100.

Definitions

  1. Current: Straight allow for the specific payor (primary, secondary, tertiary, etc.) (without COB applied)
  2. Primary: Always refers to the straight allow from the primary payor (without COB applied)
  3. Retail: Retail (MSRP) for the item
  4. Bill: Amount billed to the customer for the item
  5. RemainderFrom: Sum of all previous payor priority allowable each adjusted for COB

Options

  1. COB Type: Refer to Definitions above - Explore the effects of different COB types using the COB Calculator.
    1. Current: Straight allow for the specific payor (primary, secondary, tertiary, etc.) (without COB applied)
    2. RemainderFromCurrent: Current - RemainderFrom
    3. RemainderFromPrimary: Primary - RemainderFrom
    4. RemainderFromRetail: Retail - RemainderFrom
    5. RemainderFromBill: Bill - RemainderFrom 
  2. COB Percent: Percent applied to COB Type
  3. COB Billing Multiplier: Non primary insurances only - specify a billing multiplier to use if the allowable is MSRP times billing multiplier - The default billing multiplier is set from the billing multiplier set for the insurance in Rx Admin

Actions

  1. Edit (pencil): Click on Basic Info on left menu, in Payer/Subscriber grid select payer (Sel column) then pencil icon
  2. Update Allow Values: Click on Line Items on left menu, select Update in Mode drop down and click on the execute button
  3. View Allow Values: Click on Line Items on left menu - must update allow values after changing COB values


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