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Improved processes for identifying members subject to COB provisions and/or benefits exclusions

November 1, 2013

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We have expanded and enhanced our monitoring processing for identifying members with Coordination of Benefits (COB), including those commercial HMO, POS, and PPO members who are eligible for, but have not yet enrolled in, Medicare Part A or B. As a reminder and in accordance with applicable Benefit Program Requirements, IBC will pay as the secondary payer for services covered under an IBC commercial group benefit program (e.g., Personal Choice®, Keystone Health Plan East) if a member is eligible to enroll in Medicare Part A or B and has not done so — even if the member does not enroll for, pay applicable premiums for, maintain, claim, or receive Medicare Part A or B benefits. Therefore, it is important that you routinely ask members about other potential sources of coverage and also ask your Medicare-eligible members to show their Medicare identification cards.

For those members who are eligible to enroll in Medicare Part A or B, but have not done so, you may collect the amount under ?Member Responsibility? on your Statement of Remittance*, which includes any cost-sharing (copayment, coinsurance, deductible) plus the amount Medicare would have paid as the primary payer.

Please call Customer Service at 1-800-ASK-BLUE with any questions.

* In the case of a member who has already migrated to the new operating platform, you may collect the amount under ?Member Liability? on the Provider Explanation of Benefits. This amount includes any cost-sharing (copayment, coinsurance, deductible) plus the amount Medicare would have paid as the primary payer.

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