Coordination of Benefits

Coordination of Benefits (COB) is an optional feature that allows you to determine the expected payments due from various payors insuring a patient. For secondary and tertiary payors, the expected payment is determined by specific COB language that is included in most contracts.

To use the Coordination of Benefits feature:

  • Your organization must forward FinThrive secondary and tertiary payor plan IDs and claims data.
  • The Multiple Reimbursement Calculations (MRC) feature must be turned on for your facility. For more information about MRC, refer to Multiple Reimbursement Calculations.
  • COB must be turned on for your facility.
  • COB reprice settings and language types must be defined in your contract profiles.

Turning on COB for your facility alters the options and the data displayed in various pages throughout Contract Manager to allow you to research and review expected payment information for secondary and tertiary payors.

  • The account worklists allow you to create worklists based on secondary and tertiary payors. In your worklist results, an account number is listed with parenthetical indicators of the number of payors and number of accounts that share that account number. For example, account number 012345678 (2,3) indicates there are two payors and three accounts that share the account number 012345678.
  • A Payor Worklist allows you to create worklists at the payor level and to more easily identify secondary and tertiary expected payments. The Payor Worklist is the primary worklist used for researching Coordination of Benefits payments.
  • The Master Account Worklist allows you to specify primary, secondary, and tertiary payors as part of your worklist criteria and displays expected payment for all classes of payors when they are present on an account.
  • The Patient Account Audit page provides account information summarized at the master account level as well as by payor and allows you to drill down into the details at both levels. For secondary and tertiary payors, when they are present, this page displays the COB language method used to calculate expected reimbursements and allows you to easily toggle between reprice details for each account associated with the account number.
  • The Payment and Adjustment page summarizes information by payor and provides enhanced grouping and sorting options.
  • Overrides can be extended to multiple account records and multiple payor records.
  • The View/Edit Contract Profile pages allow you to view and define COB reprice settings and language types for each contract profile.

How To Topics

The details of the changes to each page are described in greater detail in each How To help topic that provides the step-by-step procedures for a specific Contract Manager page.