Which term describes the payer that pays first for a given claim in coordination of benefits?

• A. The payer that pays last for a given claim
• B. A payer that denies all claims
• C. The payer that pays first for a given claim
• D. A payer that only covers prescription drugs

Answer: (C)

In coordination of benefits, the payer that pays first for a claim is the primary payer. This means that plan is responsible for paying the claim first up to its allowed amount, and any remaining costs may be submitted to a secondary plan for potential additional coverage. Determining which plan is primary depends on rules such as employer or plan-specific guidelines, but the important idea is that the primary payer pays first.

The other phrases don’t describe this role. The payer that pays last would be the secondary payer, not the first to pay. A payer that denies all claims isn’t a defined role in COB, and a payer that only covers prescription drugs describes a specific benefit, not the first-payer responsibility.