Scenario
Medical claim received with other insurance EOB and Current payer has updated COB data with that insurance and other insurance is primary then update COB details according to other insurance EOB
Claim Information
| Claim ID | Patient Name | Claim Type | Provider ID | Provider Name | Provider NPI | Tax ID |
|---|---|---|---|---|---|---|
| 241211230100 | Mickey Mouse | professional | 11000000123 | Steve Smith | 1122334455 | 223344556 |
CLM Total Charges: $200.00
CLM Received Date: 04/15/2025
Claim Service Line
| Line Number | From Date | To Date | POS | TOS | Procedure | Charges | Units |
|---|---|---|---|---|---|---|---|
| 1 | 04/01/2025 | 04/01/2025 | 11 | EV1 | 99215 | $200.00 | 1 |
Other Insurance EOB
| Line Number | From Date | To Date | POS | Procedure | Charges | Units |
|---|---|---|---|---|---|---|
| 1 | 04/01/2025 | 04/01/2025 | 11 | 99215 | $200.00 | 1 |
| Line Number | Allowed | Copay | Deductible | Coinsurance | Paid | Reason Code |
|---|---|---|---|---|---|---|
| 1 | $150.00 | $50.00 | $0.00 | $0.00 | $100.00 | - |
Payment Details
| Line Number | Allowed | Copay | Deductible | Coinsurance | Benefit | COB Adjustment |
|---|---|---|---|---|---|---|
| 1 | $150.00 | $50.00 | $0.00 | $0.00 | $100.00 | $0.00 |
COB Details
Data
| Type | Order | Carrier ID | Effective Date | Term date |
|---|---|---|---|---|
| commercial | primary | C0001234 | 01/01/2025 | - |
Claim Level
| Type | Allowed | Copay | Deductible | Coinsurance | Paid |
|---|---|---|---|---|---|
| C | $150.00 | $50.00 | $0.00 | $0.00 | $100.00 |
Line Level
| Line Number | Allowed | Copay | Deductible | Coinsurance | Paid | Reason Code |
|---|---|---|---|---|---|---|
| 1 | $150.00 | $50.00 | $0.00 | $0.00 | $100.00 | - |
Outcome
Payment Details In Current Payor System After COB Update
| Line Number | Allowed | Copay | Deductible | Coinsurance | Benefit | COB Adjustment |
|---|---|---|---|---|---|---|
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