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NH Healthy Families Coordination of Benefits (COB) Coordination of Benefits Policy Clarification

Date: 08/04/17

NH Healthy Families would like to clarify the Coordination of Benefits policy when NH Healthy Families is the secondary payer. 

Primary Insurance*NH Healthy Families Responsibility
Medicare Part A & Part B Claims Billed on the UB04For Part A crossover claims, and for Part B crossover claims billed on the UB-04, NH Healthy Families will pay the patient responsibility amount (deductible and coinsurance) up to the Medicaid allowed amount.
Medicare Part B Claims Billed on a CMS-1500NH Healthy Families will pay the patient responsibility amount (deductible and coinsurance) up to the Medicaid allowed amount.
Non-MedicareNH Healthy Families is responsible to pay the difference in primary payment and NH Healthy Families allowable – if the primary payment is greater than the NH Healthy Families allowable, no payment is made.

* NH Healthy Families secondary coverage is responsible for payment depending on the primary insurance (Medicare vs. non-Medicare)

Please Note: For both Part A and Part B claims, if the patient responsibility amount is “0” then NH Healthy Families will not make a payment.

Please contact NH Healthy Families Provider Service at: 1-866-769-3085 with any questions.