When there are multiple payers, which data is included on the UB-04 claim to support coordination of benefits?

• A. The claim includes primary and secondary payer data to manage benefits
• B. A single payer covers the entire claim
• C. The claim excludes patient liability
• D. The claim uses DRG-based payment

Answer: (B)

Coordination of benefits relies on identifying who pays first and who pays second. When more than one payer is involved, the UB-04 claim must carry data that shows the primary payer and any secondary payer, so the processor can determine the correct payment sequence and each payer’s responsibility. This includes fields that identify the other payer and their policy details, allowing proper reconciliation of payments between payers and the patient.

If only a single payer is involved, coordination of benefits isn’t needed because there’s no secondary payer to coordinate with. Excluding patient liability isn’t the COB data focus, and DRG-based payment concerns how the hospital is paid rather than how multiple payers’ responsibilities are coordinated on the claim.