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).
Header or Line	2330B Or 2430	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.