CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Coordination of Benefits (COB) reimbursement

Governs how Blue Cross & Blue Shield of Rhode Island (BCBSRI) coordinates payment when another payer exists, describing secondary payer payment calculations and rules for Medicare/Medicare Advantage interactions; affects providers submitting claims to BCBSRI and covered members.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyCoordination of Benefits (COB) reimbursement

Policy CodePolicy N/A

Change TypeNo material change

Effective DateDec 20, 2001

Next Review DateN/A

Key ActionIf BCBSRI determines after payment it was not the primary insurer, retract the payment, bill the primary insurer, and resubmit to BCBSRI with the primary EOB for secondary consideration.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

12/20/2001Policy effective date

Lesser of allowance or liabilitySecondary payment rule

20%BCBSRI when secondary to Medicare

2012–2023Published updates

When BCBSRI Is Secondary

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyCoordination of Benefits (COB) reimbursement

Policy CodePolicy N/A

Change TypeNo material change

Effective DateDec 20, 2001

Next Review DateN/A

Key ActionIf BCBSRI determines after payment it was not the primary insurer, retract the payment, bill the primary insurer, and resubmit to BCBSRI with the primary EOB for secondary consideration.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

BCBSRI acts as a secondary payer; coverage and payment are subject to the rules below.

ALL of the following

Payment calculation
- Secondary payment equals the lesser of BCBSRI's allowance or the outstanding member liability after the primary payer's payment, not to exceed charges in accordance with the member's contract.
Medicare-specific rules
- If BCBSRI is secondary to a Medicare plan and the servicing provider is 'out of Medicare', BCBSRI will pay 20% of the rate per the Rhode Island Medicare Fee Schedule.
- If BCBSRI is secondary to Medicare and the servicing provider is ineligible to participate with Medicare, BCBSRI will process the claim as if it were the primary payer.

If, after payment, BCBSRI determines it was not the primary insurer, BCBSRI may retract the claim payment. The claim should then be billed to the primary insurer and resubmitted to BCBSRI with the primary insurer's EOB for secondary coverage.

Billing & Claim Actions for Providers

Billing Rule

Secondary payer payment equals lesser of BCBSRI allowance or member liability

When BCBSRI is the secondary payer, payment will be the lesser of BCBSRI's allowance or the outstanding member liability after payment by the primary payer, not to exceed charges in accordance with the member's contract.

Prior Authorization

Post-payment retraction — bill primary and resubmit with primary EOB

If BCBSRI determines after payment that it was not the primary insurer, BCBSRI may retract the claim payment; the claim should then be billed to the primary insurer and resubmitted to BCBSRI with the primary insurer's EOB for secondary coverage.

Key Terms

inv-04: Coordination of Benefits (COB) — definition of COB and order of payer responsibility

DefinitionCoordination of Benefits (COB) establishes the order in which health insurance plans pay claims when more than one plan exists.

PurposeDocuments BCBSRI payment policies and procedures when other coverage is present to determine primary and secondary payer responsibility.

Member resourcesRefer to the member's Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for specific coordination rules applicable to the member's plan.

Effective dateEffective 12/20/2001 (policy effective date).

inv-05: BCBSRI secondary payer interactions — notes on BCBSRI being secondary to Medicare (original or MAO) or other commercial products and contract variability

When BCBSRI is secondary to Medicare (provider out of Medicare)BCBSRI will pay 20% of the rate per the Rhode Island Medicare Fee Schedule.

When BCBSRI is secondary to Medicare (provider ineligible for Medicare)BCBSRI will process the claim as if it were the primary payer.

Post-payment retractionIf BCBSRI determines after payment that it was not the primary insurer, BCBSRI may retract the payment; the claim should be billed to the primary insurer and then resubmitted to BCBSRI with the primary insurer's EOB for secondary coverage.

Commercial products and Medicare AdvantageBCBSRI may be secondary to Medicare (original or MAO) or other commercial products; benefits and applicability may vary by group/contract and should be verified in the member documents.