Coordination of Benefits
Make multiple coverage records easier to reconcile. Collect plan and subscriber relationships, preserve payer responses and keep unresolved billing-order questions visible to the billing team.
How the work moves.
Two active plans do not, by themselves, establish the correct billing order.
- 01
Collect current plans and subscriber relationships.
Organize each plan separately, including the subscriber relationship and effective information.
- 02
Compare payer responses and identify unresolved billing-order questions.
Compare the available responses and surface gaps or conflicting payer-order instructions.
- 03
Record the verified order and route conflicts to the billing team.
Record the verified resolution and attach remaining questions to a responsible reviewer.
A request,
with its context intact.
A patient has two active coverage records. One payer response requests updated coordination information, and the records do not establish the billing order.
Fictional example · No patient data or external action
- Known
- Two coverage records are present
- Unresolved
- Primary and secondary billing order
- Next action
- Billing team confirms coordination with the appropriate source
Start with the
right information.
Keep these details with the request so the next person can review the work without repeating the intake.
- Current coverage records for each plan
- Subscriber relationships and relevant dates
- Patient identity and encounter context
- Available payer coordination responses
About this workflow.
Can two active plans establish payer order?
No. Active coverage alone does not settle coordination. The applicable plan information and payer responses need to support the recorded order.
What happens if the plans disagree?
Keep both responses and the conflict visible. Authorized staff resolves the discrepancy instead of silently overwriting one plan’s information.
Related workflows.
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