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Knowledge Center/ Eligibility and enrolment/ CPP-092
Eligibility and enrolment

Coordination of benefits and third-party liability

Which payer is primary, and what is recoverable when this plan paid as primary and should not have.

All policies
Current version
v4.0
in force since 2025-01-01 · as at 2026-04-02
Versions on file
1
back to 2025-01-01
Applies to
All lines of business
All states
Cited in this batch
0
no claim in this batch reached it

Where this sits

OwnerEnrolment Integrity
Lines of businessAll lines of business
StatesAll states
External basisNAIC COB model regulation · 42 CFR 433 subpart D (Medicaid third-party liability)

Version history

Newest first

A claim is tested against the version that was in force on its date of service. For a service last autumn, that is not the version at the top of this list.

v4.0 2025-01-01 → current In force now
Third-party liability is re-checked at audit, not only at adjudication.
No source document in the index. A finding on this version can cite it by name but cannot quote a passage.
  • Primacy is determined as at the date of service.
  • Medicaid is payer of last resort in every state this plan operates in.
  • Where this plan paid as primary and was secondary, the difference is recoverable.

This policy is synthetic — an internal document written for this demo. The external basis it cites is real.