Patient Coordination of Benefit

Patient Coordination of Benefit
To process claims timely and accurately, it’s important that we know if a patient has any health insurance coverage other than Blue Cross & Blue Shield of Rhode Island. If your patient has other coverage, please complete this form. You can fax it to (401) 459-1137 or mail it to:
Attn: Provider COB – 00043
Blue Cross & Blue Shield of Rhode Island
500 Exchange Street
Providence, RI 02903
Please note: In addition to completing the form, you can attach a photocopy of the front and back of the other health insurance card. This will help improve processing of the form.