In the COB process, what is the difference between primary and secondary payer?

In the COB process, what is the difference between primary and secondary payer?

• A. The secondary payer pays first, then primary.
• B. The primary payer pays first; the secondary payer pays remaining allowed charges per COB rules.
• C. Both pay the full allowed amount.
• D. COB determines only claim submission order.

Answer: (B)

In the coordination of benefits, the starting point is which plan pays first and how the rest is handled. The primary payer processes the claim first, paying up to what their policy covers, including any deductible, copayment, or coinsurance. After that payment, the secondary payer comes in to cover any remaining eligible charges, but only up to the amount left under the primary’s allowed charges and according to the secondary plan’s rules. This sequence prevents double payment and ensures the total benefits don’t exceed what the plans collectively authorize. So the correct description is that the primary payer pays first, and the secondary payer covers the remaining allowed charges per COB rules. The other statements either reverse the payment order, imply both would pay the full amount, or oversimplify COB to only submission order.

In the coordination of benefits, the starting point is which plan pays first and how the rest is handled. The primary payer processes the claim first, paying up to what their policy covers, including any deductible, copayment, or coinsurance. After that payment, the secondary payer comes in to cover any remaining eligible charges, but only up to the amount left under the primary’s allowed charges and according to the secondary plan’s rules. This sequence prevents double payment and ensures the total benefits don’t exceed what the plans collectively authorize. So the correct description is that the primary payer pays first, and the secondary payer covers the remaining allowed charges per COB rules. The other statements either reverse the payment order, imply both would pay the full amount, or oversimplify COB to only submission order.