November 20, 2003
The information in this article is no longer accurate/applicable.
Claims Crossover Process Transition to Consolidated Contractor
CMS has decided to streamline the claims crossover process to better serve our customers. The claims crossover process provides for complementary insurers to receive claims payment information from Medicare contractors based on eligibility files they provide or on claims information (Medigap) that you submit as part of your claim to Medicare.
Medicare complementary insurers (i.e., non-Medigap plans), Title XIX State Medicaid Agencies, and Medigap plans—collectively known as coordination of benefit (COB) trading partners—that are eligible to receive Medicare paid claims directly from CMS for purposes of calculating their secondary liability will no longer have to sign separate agreements with individual Medicare contractors. Each COB trading partner will now enter into one national Coordination of Benefits Agreement (COBA) with CMS' consolidated claims crossover contractor, the Coordination of Benefits Contractor (COBC). Likewise, each COB trading partner will no longer need to prepare and send separate eligibility files to Medicare intermediaries or carriers nor receive numerous crossover files.
Medicare contractors will be testing the implementation of the new process over the next several months. The expected date for the phased-approach transition of this workload to the COB Contractor is between April 2004 and October 2004. The complementary insurer eligibility file based transfers will be the first workload in the transition.
CMS will provide generic Medicare Summary Notice (MSN) and Remittance Advice (RA) messages for claims transmitted to the COBC for crossover purposes and we will keep you informed of the changes to the current process. You will continue to contact the Medicare carrier Customer Service department for your questions about an individual's crossover status.
Please watch for future communication regarding this change.
