Ken: The gist of Kepa's Myth #233: "COB claims" seems to be saying that COB (at least the Provider-to-Payer-to-Provider model) is up to the provider: if the secondary payer doesn't heed the previous amounts paid by the primary insurer, he could end up paying as a primary insurer himself! Now don't push me any further on this: I barely understand what I just wrote!! But what agreement needs to be in place between the provider and payer(s) in this case? Isn't Kepa's point mostly that insurers have a rational business imperative to support COB, regardless of any agreements between payers and providers?
I'm not obsessed over COB, mind you, but I just want to figure out what we need in the CPP to assist payers and providers in processing claims with COB. On another matter, when you talk about "a fair amount of routing," are you referring solely to the payer-to-payer type of COB? At least the Provider-to-Payer-to-Provider model seems to be no more complicated (in terms of routing) than what we've been talking about all along: i.e., provider using the payer ID to find the payer's CPP and then extracting the appropriate EDI address to which send the interchange. William J. Kammerer Novannet, LLC. Columbus, US-OH 43221-3859 +1 (614) 487-0320 ----- Original Message ----- From: "Fody, Kenneth W." <[EMAIL PROTECTED]> To: "'WEDi/SNIP ID & Routing'" <[EMAIL PROTECTED]> Sent: Monday, 08 July, 2002 10:21 AM Subject: RE: CPP and COB Larry, William, et al -- I would agree with Larry's point with regard to COB on both aspects. First, for a payer to accept a COB transaction from either a provider or another payer, there will have to be some type of agreement in place between the sender and receiver -- the same way there is with any other transaction. This is particularly true if a Payer is truly hoping to use EDI to simplify and improve their COB process, because real improvement requires a lot more work than just taking in an 837. Second, I agree with Larry that CPP is valuable in this context and I would offer a some details on why that is true. Independence Blue Cross and Aetna are the two biggest players in the tri-state Philadelphia area (e.g. PA/southern NJ/DE). Lets say we decided to collaborate on COB. If you look behind the curtain, you'll see Aetna is not just one company. Rather Aetna is a lot of different HMOs -- probably at least one for every state in which they do business -- and some insurance companies all trading under the name Aetna. And the same is true for us, albeit not on as grand a scale. We do business in just three states, but we have six different entities underwriting coverage and a TPA. All of these use the same entry point for electronic transactions. So, as you can see, when two carriers get together to do COB, Larry is correct when he says it is not just a connect and send type of arrangement. There clearly is a fair amount of routing that has to take place, which depends on one party correctly identifying the other carrier to whom they are sending the transaction. As Larry said, anything that makes that process easier is a good thing. Ken Fody Independence Blue Cross discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. Posting of advertisements or other commercial use of this listserv is specifically prohibited.
