A patient’s claim is denied for coordination of benefits because the clinic billed the secondary payer as primary. What is the appropriate remediation focus?
Select an answer to reveal the explanation.
Short Explanation
COB denials are a “wrong cashier” problem—you asked payer B to go first when payer A was primary. Fix the order, then resubmit. Arguing medical necessity while the payer sequence is wrong just spins the wheels.
Full Explanation
Coordination of benefits denials indicate incorrect sequencing of responsible payers. Remediation requires updating primary/secondary (and additional) payer order based on verified benefits and resubmitting in the proper sequence. Medical-necessity appeals, automatic write-offs, or CPT-only changes without correcting COB order do not resolve the root cause on professional claims.