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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 UB04 For 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-1500 NH Healthy Families will pay the patient responsibility amount (deductible and coinsurance) up to the Medicaid allowed amount.
Non-Medicare NH 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.