Freemed-YiRC - MACSIS COB (Coordination of Benefits)
The term MACSIS COB (Coordination of Benefits) relates to clinical billing in the State of Ohio where both Medicare and other insurance (or other payers) is involved. MACSIS is the the payer of last resort, so before it can be billed to, all other means of payment must first be tried.
After insurance/other payer benefits have been exhausted (or have been deemed non-cooperative), then MACSIS can be billed. However, additional information must be sent to MACSIS in the clinical billing to indicate the presence of another payer, and as well to indicate the status of that payer (i.e., benefits exahaused, non-cooperative, etc...)
When billing MACSIS via the HIPAA EDI 837 format using COB, the following loops must be added:
- Loop 2320 - Other Subscriber Information
- Includes information relating to the insurance such as subscriber relationship to client, insurance type, other payment amount (per claim), and subscriber DOB & gender.
- Loop 2330A - Other Subscriber Name
- Includes the subscriber name and insurance member ID.
- Loop 2330B - Other Payer Name
- Includes the name of the insurance company/other payer (i.e., Blue Cross, Anthem, etc...)