Coordination of Benefits (COB) Appeal Letter

Use this when a payer won't pay until the primary/secondary order is resolved. It's usually a sequencing problem, not a coverage problem — the fix is the primary EOB and the correct order of benefits.

What makes it win

• Attach the primary payer's EOB/remittance so the secondary can coordinate
• State the correct order of benefits and the basis (birthday rule, active-vs-retiree, Medicare secondary rules)
• Note if the member's COB record on file is outdated and provide the current coverage facts
• Reference the primary EOB date, which also frames timely filing for the secondary

The template

Replace the [BRACKETED] fields with your details. This is the manual version of the appeal Volari files for you automatically.

[PRACTICE LETTERHEAD]
[DATE]

[PAYER NAME] — Appeals Department
[PAYER APPEALS ADDRESS]

RE: Appeal of Coordination of Benefits Denial (CARC 22)
Patient: [PATIENT NAME]   Member ID: [MEMBER ID]
Claim #: [CLAIM NUMBER]   Date of Service: [DOS]

To the Appeals Department:

We are appealing the COB denial for the above claim. The order of benefits is resolved and the primary payer's remittance is enclosed so [PAYER] can coordinate as [primary / secondary].

Order of benefits: [PRIMARY PAYER NAME] is primary and [PAYER NAME] is secondary, per [birthday rule / active-employee-vs-retiree / Medicare secondary payer rules]. [PRIMARY PAYER] adjudicated the claim on [PRIMARY EOB DATE], paying [AMOUNT] and leaving [AMOUNT] for secondary coordination.

[IF COB RECORD STALE: [PAYER]'s COB record for this member appears outdated. Current coverage is: [FACTS]. The member has [confirmed / is updating] this with [PAYER].]

With the primary EOB now on file, we request the secondary claim be processed. Please contact [CONTACT NAME] at [PHONE].

Enclosed: primary payer EOB/remittance dated [PRIMARY EOB DATE].

Sincerely,
[BILLING MANAGER NAME], [TITLE]
[PRACTICE NAME] — NPI [NPI]   TIN [TIN]

Common questions

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