Subrogation and Coordination of Benefits (COB)

Subrogation Standards

Brighton has the right to recover benefits paid for a member’s health care services when a third party causes the member’s injury or illness to the extent permitted under state and federal law and the member’s benefit plan.

Coordination of Benefits (COB) Standards

COB is administered according to the member’s benefit plan and in accordance with law. BHN accepts secondary claims electronically.

A provider’s contracted rates will not be used to determine coordination of benefits responsibility for programs where a government unit is a primary payor. Total payment, by BHN or payor, as applicable, in addition to any primary coverage payment, will not exceed that of the BHN contracted rate or that allowed by the primary payor.

Provider shall determine whether a patient’s illness or injury is covered by auto insurance, other primary health coverage, or otherwise gives rise to a claim by a payor by virtue of coordination of benefits or subrogation and shall seek compensation from those primary payors first if BHN or Payor, as applicable is secondarily liable.