Why is coordination of benefits important to an MCO?
Coordination of benefits requires identification of the primary insurance payer. In some cases, patients may have two insurers, such as one through an employer and a purchased HMO policy to supplement the basic policy. The MCO has to coordinate the benefits to ensure that the primary insurance payer is billed first. The MCO may be the secondary payer—which means that the MCO would pay a percentage of the unpaid balance once the primary insurance has paid.
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