Top Provider Questions – 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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Please reference the CMS website for additional information:
Reviewed 10/30/2023
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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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