Harvard Pilgrim accepts electronically submitted commercial coordination of benefit (COB) claims. COB is a way of coordinating benefits when a member is covered by more than one health care plan to ensure that members receive the benefits to which they are entitled and that claims are paid correctly by the health plans.
When submitting commercial COBs electronically, you must complete the following additional loops in the EDI claim to report the other payer(s) information:
- Loop 2320 Other Subscriber Information — reports the 835 claim payment and claim-level adjustments from other payer(s)
- Loop 2330A Other Subscriber Name — reports other payer(s) subscriber name and identification
- Loop 2330B Other Payer Name — reports other
payer(s) name and identification
- Loop 2330C through 2330G in professional claims, and 2330C through 2330I in institutional claims, as appropriate — these are other payer's attending, operating, referring, rendering, supervising, and billing provider, as well as service facility
- Lop 2430 Line Adjudication Information if applicable — reports other payer(s) claim line-level adjustments when other payer adjudicated claim at the line level
Commercial COB EDI claims that are submitted without the necessary information about the other payer may be denied for missing, incomplete, or invalid information. All other EDI claims requirements must also continue to be met.
Also, please note that Harvard Pilgrim receives and processes Medicare crossover claims for our Medicare Enhance and Medicare Supplement products; providers do not need to submit Medicare COB claims to Harvard Pilgrim.
If you have any further questions about commercial EDI COB claims, please contact Harvard Pilgrim’s EDI Team at EDI_Team@harvardpilgrim.org.