COB Playbook

Helpful Hints Before Digging Deeper into COB

** Remember, the patient must be covered under an EGHP for a 30-month COB period to be possible. **

Medicare will always be primary over:

Medicare and Veterans Affairs (VA) Medicare and VA are both federally- funded programs, therefore DaVita should not have both programs together in a patient’s coverage string. In other words, we should never have Medicare and VA set for the same claim in primary, secondary or tertiary positions. If ESRD was caused by a service related injury, VA is responsible for the care of the patient. If VA cannot provide the service due to not having a facility or hospital in a nearby area, they may provide an authorization for the care to be outsourced.

 Medicaid / Managed Medicaid  Medigap Plans  True supplement plans that would not pay if the patient didn’t have Medicare  State Renal Plans  Indian Health Services (IHS)  TRICARE for Life  CHAMPVA  Individual commercial policies  Example: Self–employed patient purchases Cigna plan for their family. Since

they are self-employed, there is no “employer group”

For ESRD injury claims, Medicare will never be primary over:

 Worker’s Compensation plans  Liability policies  No-fault insurance claims (Such as auto liability)