What documentation is typically included with the secondary submission in a COB scenario?

• A. A copy of the original claim.
• B. EOBs (explanation of benefits) from the primary payer.
• C. Patient's driver license.
• D. No documentation is needed.

Answer: (B)

In a coordination of benefits situation, the secondary payer needs to know how the primary payer adjudicated the claim to determine what remains payable. The documentation typically included with the secondary submission is the primary payer’s Explanation of Benefits (EOB). The EOB shows what the primary payer paid, what the patient is still responsible for, any discounts or adjustments, and the reason codes for any reductions or denials. This information allows the secondary payer to accurately determine their own liability and prevent duplicate payments or miscalculation.

A copy of the original claim isn’t sufficient on its own because it doesn’t reveal how the primary payer processed the claim. A patient’s driver license is not relevant to payment adjudication, and saying no documentation is needed is incorrect since the secondary payer requires primary adjudication details to process correctly.