Did You Know? – Coordination of Benefits (COB)
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- What is the Benefits Coordination & Recovery Center?
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The BCRC consolidates the activities that support the collection, management, and reporting of other insurance coverage for Medicare beneficiaries. The purposes of the COB program are to identify the health benefits available to a Medicare beneficiary and to coordinate the payment process to prevent mistaken payment of Medicare benefits. Note: The BCRC does not process claims, nor does it handle any mistaken payment recoveries or claims specific inquiries. The Medicare carriers are responsible for processing claims submitted for primary or secondary payment.
Reviewed 6/14/2021
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- Do Medicare contractors cross over claims to supplemental payers/insurers?
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No, CMS implemented the Coordination of Benefits Agreement (COBA), which states that the Benefits Coordination and Recovery Center will process all claims crossovers. Government Health Incorporated (GHI) is the contractor selected by CMS.
Reviewed 6/14/2021
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- How are claims crossed over?
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An eligibility file is sent from the Trading Partner (supplemental insurance company) to the BCRC. The file contains data to identify the Medicare ID number and claims criteria, specified by the Trading Partner, for crossovers. Each Trading Partner is issued a COBA ID. The COBA ID and eligibility file data, along with information specific to that trading partner, are stored in Medicare's Common Working File (CWF). When claims are processed, CWF compares each COB trading partner's claims selection criteria against the Medicare claims. If the claim matches the Trading Partner's claims criteria and the Medicare ID number in their eligibility file, the claim information is automatically forwarded to the Trading Partner, via an electronic file.
Reviewed 6/14/2021
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- When should I contact the BCRC versus my Medicare contractor?
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Contact the BCRC to:
- Report employment changes, or any other insurance coverage information.
- Report a liability, auto/no-fault, or workers compensation case.
- Ask general Medicare Secondary Payer (MSP) questions/ concerns.
- Ask questions regarding Medicare Secondary Development (MSP) letters and questionnaires.
Contact your local Medicare intermediary or carrier to:
- Answer your questions regarding Medicare claim or service denials and adjustments.
- Answer your questions concerning how to bill for payment.
- Process claims for primary or secondary payment.
- Accept the return of inappropriate Medicare payment.
Reviewed 6/14/2021
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- Whom do I contact if my remittance advice shows that a claim crossed over and the supplemental insurance company has not received it?
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Because Medicare no longer crosses over claims, you will need to contact the Trading Partner so they may investigate the situation to confirm if it is an internal issue or an issue with the BCRC.
Reviewed 6/14/2021
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- Who do I contact if Medicare records indicate that claims have crossed over but the trading partner says they did not, or if I am experiencing problems with claims being forwarded to other payers?
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This situation could suggest that some type of error occurred during the crossover process from the Medicare contractor to the BCRC or from the BCRC to the trading partner. In order to determine if such an error occurred or if a problem exists, the trading partner must contact the BCRC. The BCRC will correct any possible issues on their end, or report to the contractor any issues that require action on the part of the contractor. The Contractor can verify whether Medicare claims processing records indicate crossover; however, when our records indicate that claims did not crossover, we cannot provide any specifics on the trading partner's criteria.
Reviewed 6/14/2021
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- If supplemental insurer information is not on the claim, will it still crossover?
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Yes. The CWF includes the eligibility file that contains specific information pertaining to the trading partner contracted with the BCRC. As Medicare claims are processed, CWF applies each COB Trading Partner's claims selection criteria against the Medicare claim. The COBA ID of the trading partner and their eligibility file data are stored in CWF. The eligibility file is sent from the Trading Partner to the BCRC. The file contains data to identify the claims for cross over.
Reviewed 6/14/2021
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- What is the telephone number for the Benefits Coordination and Recovery Center?
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Customer Service Representatives are available Monday through Friday, from 8:00 a.m. to 8:00 p.m., Eastern Time, except holidays, at toll-free lines: 1-855-798-2627 or TTY/TDD: 1-855-797-2627 for the hearing and speech impaired.
Reviewed 6/14/2021
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- What information will the BCRC assist you with?
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All Customers
- Answers to general questions regarding Medicare Secondary Payer (MSP).
- Requests for duplicate questionnaires.
Beneficiaries
- Answers to questions regarding the Initial Enrollment Questionnaire (IEQ), Secondary Claim Development (SCD) questionnaires, and Trauma Development (TD).
- Information regarding other payers that may be primary to Medicare's primary/secondary status.
- Reporting any changes to your health coverage
- Reporting a liability, auto/no-fault, or workers' compensation (WC) lawsuit.
Providers
- Verification of Medicare's primary/secondary status. Note: Insurer information will not be released. The provider must request information on payers primary to Medicare from the beneficiary prior to billing. Since we must protect the rights and information of our beneficiaries, we cannot disclose this information.
- Reporting changes to a beneficiary's health coverage.
- Reporting a beneficiary's accident/injury.
Reviewed 6/14/2021
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- What information will the BCRC not assist you with?
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Beneficiaries
- Information regarding denial of a claim or service on your claim for a reason other than MSP - contact 1-800 Medicare.
- Information regarding replacement of your Medicare card, enrolling in Medicare, changing your address, or verifying Medicare coverage - contact the Social Security Administration (SSA) at 1-800-772-1213, Monday through Friday, from 7:00 a.m. through 7:00 p.m., Eastern Time.
- General Medicare information, information about Medicare health plan choices, and information on ordering Medicare publications - contact 1-800-Medicare.
Providers
- Information concerning how to bill for payment (e.g., value codes, occurrence codes) - contact the local Medicare contractor for this information.
- Contact the local Medicare contractor regarding inquiries related to specific claims or recoveries.
- Information regarding beneficiary entitlement data. Current regulations do not allow the BCRC to provide entitlement data to the provider.
- Insurer information. The BCRC is permitted to state whether Medicare is primary or secondary but cannot provide the name of the other insurer. It is very important that the provider obtain this information from the beneficiary since the new Privacy Act prohibits the release of this information.
Reviewed 6/14/2021
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