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Coordination of Benefits Agreement
Effective October 1, 2004, the Centers for Medicare & Medicaid Services (CMS) will begin the implementation of a new and improved way for other health insurers to streamline the current Medicare crossover claims process. Under CMS' consolidated crossover process, trading partners that include Medigap plans, employer supplemental plans, self-insured plans, TRICARE for Life, Title XIX State Medicaid Agencies, and others will no longer have to sign separate agreements with individual Medicare contractors to receive Medicare paid claims data for the purpose of calculating their secondary payment liability.
The new Coordination of Benefits Agreement (COBA) Program establishes a uniform national contract between CMS and other health insurance organizations. The CMS will transfer claims crossover responsibilities from individual Medicare contractors to a national claims crossover contractor, the Coordination of Benefits Contractor (COBC). This consolidation will allow for the establishment of unique identifiers (COBA IDs) to be associated with each contract and create a national repository for COBA information.
The COBA crossover consolidation initiative will initially be implemented on a small-scale during the period from July 6, 2004, to October 1, 2004. During this time, approximately ten COBA trading partners that will serve as beta-site testers will participate in a COBA pilot test period. Implementation of the COBA process will begin on a larger scale in October 2004.
How Does the Coordination of Benefits Agreements Work?
Through the consolidated claims crossover (or COBA) process, trading partners will no longer need to submit separate eligibility files to CMS’ local Medicare contractors to identify their covered members nor will they receive numerous identifiers, crossover claims files and separate invoices from these entities. Trading partners will continue to generate eligibility files using the same format that is in effect today. The COBC will transfer claims to trading partners in the Health Insurance Portability and Accountability Act (HIPAA) ANSI-X12N 837 COB (version 4010-A1) and National Council for Prescription Drug Programs (NCPDP) Batch 5.1 formats. All eligibility file-based trading partners will be transitioned from their existing crossover agreements to national COBAs during the period between October 1, 2004, to April 30, 2005. Under current planning, the COBC will assume responsibility for the Medigap claim-based crossover beginning in October 2005.
How to Enroll in the COBA Program?
To get started, simply click on the links at the bottom on the page. For additional information about the COBA program, email us at COBVA@GHIMEDICARE.COM or contact the COBC at 1-800-999-1118 or TTY/TDD 1-800-318-8782 for the hearing and speech impaired, Monday through Friday, from 9:00 a.m. - 5:00 p.m., Eastern Standard Time, except holidays.
