CoordinationOfBenefits

Coordination of Benefits data for a secondary claim, derived from primary claim ERA and manual overrides

Fields

has_manual_overrides · Boolean! · required · Whether any claim-level or line-level manual overrides exist

other_ins_dob · ISO8601Date · Primary subscriber date of birth

other_ins_first_name · String · Primary subscriber first name

other_ins_group_num · String · Primary insurance group number

other_ins_last_name · String · Primary subscriber last name

other_ins_member_id · String · Primary subscriber member ID

other_ins_relationship · String · Patient relationship to primary subscriber

other_payer_id · String · Payer ID of the primary insurance

other_payer_name · String · Name of the primary insurance payer

primary_adjudication_date · ISO8601Date · Date the primary payer adjudicated the claim

primary_paid_amount · Float · Total amount paid by the primary payer

service_line_adjustments · [CobServiceLineAdjustment!]! · required · Per-service-line COB data

Used By

Claim.coordination_of_benefits

Definition

"""
Coordination of Benefits data for a secondary claim, derived from primary claim ERA and manual overrides
"""
type CoordinationOfBenefits {
  """
  Whether any claim-level or line-level manual overrides exist
  """
  has_manual_overrides: Boolean!

  """
  Primary subscriber date of birth
  """
  other_ins_dob: ISO8601Date

  """
  Primary subscriber first name
  """
  other_ins_first_name: String

  """
  Primary insurance group number
  """
  other_ins_group_num: String

  """
  Primary subscriber last name
  """
  other_ins_last_name: String

  """
  Primary subscriber member ID
  """
  other_ins_member_id: String

  """
  Patient relationship to primary subscriber
  """
  other_ins_relationship: String

  """
  Payer ID of the primary insurance
  """
  other_payer_id: String

  """
  Name of the primary insurance payer
  """
  other_payer_name: String

  """
  Date the primary payer adjudicated the claim
  """
  primary_adjudication_date: ISO8601Date

  """
  Total amount paid by the primary payer
  """
  primary_paid_amount: Float

  """
  Per-service-line COB data
  """
  service_line_adjustments: [CobServiceLineAdjustment!]!
}