What refers to the provision in health insurance policies that specifies which coverage is primary or secondary?

Prepare for the NHA Billing and Coding Specialist exam. Study effectively with flashcards and multiple-choice questions offering explanations and hints. Ensure you're ready for success!

Coordination of Benefits is the correct answer as it specifically refers to the process utilized by health insurance providers to determine the order in which multiple insurance policies will pay for claims when an individual is covered by more than one policy. This provision is crucial for preventing overpayment and ensuring that payments are made by the primary insurance first, followed by the secondary.

Coordination of Benefits involves evaluating which plan is responsible for coverage based on factors such as the type of policy, the relationships of the insured individuals to the policyholders, and the specific terms outlined in the insurance contracts. Understanding this mechanism is vital for billing and coding specialists, as it affects how claims are submitted and managed.

The other choices do not pertain directly to this specific process. Claims Processing refers to how claims are submitted, reviewed, and paid, while Beneficiary Rights refer to the legal entitlements of individuals receiving healthcare benefits. Network Agreements relate to the contracts between providers and insurance companies regarding the services offered and benefits covered. Thus, they do not encapsulate the idea of primary and secondary coverage in the same context that Coordination of Benefits does.

Subscribe

Get the latest from Examzify

You can unsubscribe at any time. Read our privacy policy