Coordination of Benefits
Calculate patient responsibility when multiple payers are involved
Primary Payer
Payer responsible for payment first
Secondary Payer
Payer responsible after primary
COB History
| Claim ID | DOS | Billed | Primary Paid | Secondary Paid | Patient Resp. | Method |
|---|---|---|---|---|---|---|
| CLM-2025-047221 | 2025-03-01 | $1,840.00 | $1,288.00 | $276.00 | $276.00 | Coord. |
| CLM-2025-039118 | 2025-02-14 | $640.00 | $448.00 | $128.00 | $64.00 | Coord. |
| CLM-2025-028844 | 2025-01-22 | $3,120.00 | $2,184.00 | $624.00 | $312.00 | Non-Dup |
Line-Level COB
Per-procedure COB calculation for multi-line claims
| Line | CPT | Description | Billed | Primary Paid | Secondary Pays | Patient |
|---|---|---|---|---|---|---|
| 1 | 99214 | Office Visit — Moderate Complexity | $285.00 | $199.50 | $50.75 | $34.75 |
| 2 | 93000 | Electrocardiogram | $92.00 | $64.40 | $18.40 | $9.20 |
| 3 | 85025 | Complete blood count | $48.00 | $33.60 | $9.60 | $4.80 |
| Totals | $425.00 | $297.50 | $78.75 | $48.75 | ||
Dental COB
Dental plan coordination using Maintenance of Benefits method
Primary Annual Max
$1,500.00
Used: $842.00
Secondary Annual Max
$1,000.00
Used: $317.00
Patient Paid YTD
$247.50
This plan year
| Procedure | CDT Code | Fee | Primary % | Secondary % | Patient |
|---|---|---|---|---|---|
| Composite Filling — 2 surf. | D2150 | $195.00 | 80% ($156) | 15% ($29.25) | $9.75 |
| Crown — Porcelain | D2740 | $1,250.00 | 50% ($625) | 25% ($312.50) | $312.50 |
| Oral Exam — Comp. | D0150 | $85.00 | 100% ($85) | 0% ($0) | $0.00 |