Crossover Claims Resource Page
The Centers for Medicare & Medicaid Services (CMS) consolidated the "automatic" or eligibility file-based crossover process under the Coordination of Benefits Contractor (COBC) as of September 2006. Under the "automatic" crossover process, other supplemental insurers, including Medicaid agencies, sign a standard national Coordination of Benefits Agreement (COBA) with the CMS Contractor, the COBC. They then submit enrollment information via a standard eligibility file feed through a secure connection with the COBC. Within this eligibility feed, the supplemental insurers identify their covered members or policy/certificate holders for Medicare claim matching purposes. The COBC, in turn, transmits this information to the CMS Common Working File (CWF). After the CMS CWF system tags individual claims for crossover to a designated insurer, it then prompts the Medicare contractor to send the adjudicated claims to the COBC for crossover purposes once the claims have met their payment floor requirements, as prescribed by CMS.
Please see the following MLN Matters Article for more information regarding the Medicare Crossover Process:
- Important Information Regarding the Centers for Medicare & Medicaid Services (CMS) National Claims Crossover Process. - MLN Matters PDF Document SE0909
Additional Resources
- Coordination of Benefits Contractor (COBC) Frequently Asked Questions
- Centers for Medicare & Medicaid Services (CMS) Coordination of Benefits Contractor page
- Important Information Regarding the Centers for Medicare & Medicaid Services (CMS) National Claims Crossover Process. - MLN Matters PDF Document SE0909
- Clarification Regarding the Coordination of Benefits Agreement (COBA) Medigap Claim-based Crossover Process - MLN Matters PDF Document MM5837
