Coordination of Benefits Claims: Include Required Data Elements

Tufts Health Public Plans, Tufts Health Plan SCO, Tufts Medicare Preferred

December 01, 2022  

Tufts Health Plan is enhancing the processing of Coordination of Benefits (COB) claims submitted via EDI. The new process will allow for electronic COB claims to be accepted and auto adjudicated — resulting in streamlined submission and processing of these claims.
For appropriate adjudication of COB claims, complete and accurate information from the primary payer claim is required. Effective for claims received on or after Feb. 1, 2023, Tufts Health Plan will require that COB claims include the data elements listed below. Claims submitted without this information will be rejected.

Header/Line Loop Reference Codes Field
Header 2320 AMT   COB Payer Amount Paid
(Total amount paid by the other insurer)
Header 2330B NM1   Other Payer Name
Line 2430 SVD02 AMT Monetary Amount
(Line amount paid by the other insurer)
Line 2430 CAS01 CO 45 
CO 96
 CO 97
Claim Adjustment Group Code - Contractual Obligations
(Amount not paid by the other insurer due to contractual obligations. If the Billed Amount is not equal to the sum of the Paid, Deductible, Coinsurance and Copay, then CO 45, 96 or 97 and an amount must be provided.)
Line 2430 CAS01 PR
Claim Adjustment Group Code - Patient Responsibility
(Patient responsibility after payment by the other insurer). 
DTP   Claim Check or Remittance Date
(Date that other insurer paid the claim/line.)

For additional information, please refer to the updated 837 Health Care Institutional & Professional Claims Transactions: Standard Companion Guide.