The following are resources to help you when coordinating benefits for your patients.

COB Billing Guide

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The COB Calculator is available to providers in the Calculators section on VSPOnline.

Available for Signature, Choice, Advantage and MESSA plans.

Be sure to verify who is primary versus secondary before using the calculator.

Since some clients have restrictions, check for COB rules that would over-ride the COB Calculator.

For Exam-only claims, you can select either the Glasses or the Contacts tab.

• Be sure to check for eligible services:
• Verify whether the patient has already used or is using all applicable services under the primary plan to maximize their coverage.
• Verify service availability on the Secondary Plan that the patient will use toward the Primary Plan's out-of-pocket expenses.

Steps to Using the Calculator

1. On the appropriate Tab (Glasses or Contacts), uncheck any services the patient does not want to use or is not eligible.

2. Calculate the patient’s out-of-pocket expenses from the primary plan and enter them into the calculator.

3. Select the Secondary Plans Benefit type, enter secondary copays, and select calculate to determine the COB amount.

• For contact lenses, providers can refer to the patient record report and enter the secondary contact lens allowance, except for MESSA.
• Uncheck the Exam for Total Plans. This will block the value for the exam, which is only available for Exam And plan.

4. The results section will summarize the Primary Plan's out of pocket, the eligible Secondary Allowances (based on the services checked to coordinate) and Payable amounts.

VSP will apply secondary allowances to similar services first. If any allowance remains, VSP will apply the amount to any other eligible services.

How do I determine primary versus secondary?

•  Please refer to the Coordination of Benefits section of the Provider Reference Manual.

 Which services can coordinate?

• The secondary plan may COB using only those services that were provided under the primary plan, as long as the patient is eligible for those services under the secondary plan. For example, if the patient receives exam and lenses, the secondary plan can only COB the exam and lens services, if eligible.
• Secondary allowances are cumulative. The value of the secondary plan's eligible services can be applied to all applicable services received on the primary plan.

How does the calculator know what the secondary allowances are?

•  The calculator has been designed with the secondary allowances for each service checked under “Service to Coordinate” section based on the VSP Secondary plan type.
• The calculator is not available for Allowance, Medicaid or secondary plans with another carrier.

How does the calculator know the patient's contact lens allowance for the Secondary plan?

• Since it varies by each group's plan, enter the Secondary Contact Lens Allowance for all plans, except if MESSA is the Secondary Plan (MESSA 1, 2, 3, 3+, Bronze/Silver/Gold or Platinum). Note: Effective 1/1/2021, MESSA Choice plans use the Choice Secondary Plan allowances, less copay.
• Enter the contact lens copay for the Secondary plan, if the client has one. This is not common. Do not include the Secondary plan’s copay for a covered contact lens exam.