AHIP Practice Exam

The term 'coordination of benefits' specifically refers to the process of determining which insurance coverage is primary when an individual is covered by more than one insurance policy. This is important to avoid paying more than what is necessary for healthcare services. Insurers use a set of guidelines to decide which policy pays first and how benefits from secondary insurance will be utilized to cover remaining costs. By establishing a primary and secondary payer, coordination of benefits helps ensure that the patient receives the full benefits they are entitled to while minimizing delays in payment to the healthcare provider.

In contrast, resolving billing disputes between providers does not fall under the coordination of benefits as it focuses on payment issues rather than determining which insurance policy contributes first. Similarly, managing out-of-network care claims or establishing copayment amounts are processes unrelated to the specific function of coordinating multiple insurance benefits. Thus, the correct answer captures the essence of what coordination of benefits entails, streamlining the payment of claims across different insurers.