To determine the benefits payable under the COB provision, use all of the following guidelines EXCEPT:

a. Compute the normal liability (NL), both Basic and Major Medical benefits, that would be payable in the absence of Medicare (perform a line-for-line calculation).
b. Determine the amount the provider is allowed to collect.
c. Use the greater of number one or number two as the base.
d. Compare the amount paid by Medicare to the base.

C

Health Professions

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