Coordination of benefits (COB) allows health plans to determine their respective payment responsibilities in cases where a patient is covered by more than one health plan. Harvard Pilgrim is simplifying our coordination of benefits process to make it more efficient and convenient for providers.
Some claims include information that suggests that another payer may be financially responsible. In these cases, Harvard Pilgrim requests that members complete a questionnaire to help validate coverage. Currently, Harvard Pilgrim denies COB claims until the member completes the questionnaire provided. Beginning with claims processed on or after July 1, 2015, Harvard Pilgrim will issue payment on COB claims to the provider, prior to receiving a completed questionnaire.
Members have 60 days after receiving the questionnaire to complete it, and will be sent periodic reminders. Only in those cases where a member doesn’t return a completed questionnaire in a timely manner will Harvard Pilgrim retract the claim payment and the member will be financially responsible. If this occurs, the provider should bill the member for payment.
If you have any questions about our coordination of benefits policy, please contact the Provider Service Center at 800-708-4414.