Increase in Aetna COB Claim Issues

Aetna sent out the message below last week so I thought I would pass it on.

Date:

June 28, 2019

Purpose:

We’d like to let you know that incomplete and erroneous electronic Coordination of Benefits (COB) claims submissions are resulting in processing and payment delays.

Overview:

Incomplete and erroneous COB submissions have significantly affected our claims auto-adjudication process and has resulted in delayed payments while waiting for additional information from a billing provider or billing vendor.

We’ve noticed an increase in the number of electronic claims submitted with a “Y” response in the COB indicator field.

• A “Y” response in the COB indicator field should be entered only if other coverage exists.
  • All subsequent COB data fields must be populated as well, including the name of the other carrier, the name of the subscriber’s employer, and the corresponding policy number. 
• If the patient does not have other coverage, an “N” must be populated in the COB indicator field.
  • All subsequent COB data fields should be left blank. Random characters or symbols must not be populated in these fields.

Required action:

• Please review your systems to ensure the COB indicator field isn’t pre-populated with a “Y” response. If so, please remove the automatic designation. The appropriate response for each new claim submission must be entered as outlined in the information above.