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Coordination of Benefits and Subrogation __________________________________________________________
Subrogation and Coordination of Benefits
All Hometown Health Benefit Plans are subject to subrogation and Coordination of Benefits rules .
Subrogation means the recovery of benefits paid for a member ’ s health care services when a third party causes the member ’ s illness or injury . Hometown Health reserves the right to subrogate benefits to the extent permitted under applicable state and federal law and the applicable benefit plan .
Coordination of Benefits ( COB ) means a process by which another group health plan or Medicare may be responsible for claims payment either as the primary or secondary carrier .
When Hometown Health is the secondary payer , the primary carrier must be billed first . Both carriers must be billed the same amount for services performed . All claims must be submitted with the primary carrier ’ s Explanation of Benefits ( EOB ) in order to be considered for payment . If the primary carrier ’ s EOB is not attached to the claims submission , the adjudication of the claim may be delayed or denied .
Hometown Health coordinates benefits up to the lowest allowable . This is done at the line level . The lowest allowable is determined in many ways such as :
• The primes allowable being lowest
• Hometown Health ’ s allowable being lowest
• A combination of both prime ’ s allowable and Hometown Health ’ s allowable due to multiple lines within the claim
All electronic payment edits still apply if Hometown Health is the secondary payer . Please submit secondary payer claims to :
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Hometown Health P . O . Box 981703 El Paso , TX 79998-1703 EDI Payer : 88023