Updated information on COB Questionnaire for out-of-area members

June 30, 2016

Coordination of benefits (COB) refers to how Blue Plans ensure that members receive full benefits and preventsdouble payment for services when members have coverage from two or more sources. When providing services toout-of-area* Blue members, it is important to have them complete the COB Questionnaire for the following reasons:

  • streamlines claims processing;
  • expedites payment to providers;
  • reduces the number of denials related to COB;
  • enables employer groups to finalize out-of-area claims for their employees.

Please ask all out-of-area Blue members to complete this questionnaire prior to rendering services to ensure thateach claim is paid quickly and properly.

Updated mailing address and fax number

Download the latest version of the BlueCard® COB Questionnaire, which contains an updated mailing address and fax number for submitting the form. You can access the updated form in the following ways:

  • Websites. Visit our BlueCard webpage or go to the BlueCard section of ourProvider News Center.
  • NaviNet® web portal. Select Independence from My Health Plans, and then select BlueCard COB Questionnairefrom the BlueExchange® Out of Area option in the Workflows menu.

Instructions for completing the questionnaire

Out-of-area Blue members should complete the COB Questionnaire with other registration forms. Office staff shouldcomplete the first two fields of the questionnaire ? provider name and NPI ? and the out-of-area member shouldcomplete the remaining sections of the questionnaire before services are rendered.

Please immediately process the completed questionnaire by faxing it to 215-238-7915 or by mailing it to:

  • Independence Blue Cross
  • 1901 Market Street
  • Philadelphia, PA 19103

If you have any questions about this important process, please contact your Network Coordinator.

Note: The BlueCard COB Questionnaire should not be used for local Independence members or Federal Employee Program members.

*Out-of-area members are members of other Blue Cross® and Blue Shield® plans who travel or live in the Independence five-county service area, which includes Philadelphia, Bucks, Montgomery, Chester, and Delaware counties.

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