What is a coordination of benefits denial?

A coordination of benefits denial occurs when the payer cannot process the claim correctly because the patient's primary and secondary insurance order is missing, incorrect, or not updated.

COB determines which payer is responsible for processing first.

Denials may occur when:

• The payer believes another plan is primary
• The patient has not updated COB information
• The claim was sent to the secondary payer before primary adjudication
• Other insurance information is outdated

AR staff should verify the correct insurance order for the date of service and obtain or transmit the required primary remittance information when billing secondary coverage.

• COB determines payer order.
• Patient insurance information may need updating.
• Secondary claims often require primary adjudication data.
• Correct order should be verified for the date of service.

A commercial payer denies because it believes Medicare is primary, but the patient's employment status indicates the group plan may be primary under the applicable rules. The account requires COB verification before resubmission.

• Billing secondary before primary processing.
• Assuming current COB applies to older dates of service.
• Sending repeated claims without updating payer records.

Explain that COB denial resolution begins with payer-order verification, not claim resubmission.