Medicare Coordination of Benefits rules: a patients’ guide

Having coverage by more than one health program sounds great but not knowing the coordination of benefits (cob) rules can lead you to a situation where your medical claims might get denied..

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When having more than one health plan coverage, such as Medicare and health insurance, COB is a process that dictates who pays first (primary payer) for your medical costs and who pays second (secondary payer). 

If you’re someone who’s eligible for Medicare and also has another insurance plan, then knowing the rules of COB can save you lots of money. So what are those rules? Read this article to learn the key “ifs and buts”.

Medicare Coordination of Benefits rules

In 1971, the (NAIC) National Association of Insurance Commissioners issued its set of coordination of benefits Medicare guidelines. The model serves as an example for insurers and state legislatures to adopt a consistent set of Medicare COB rules. Let’s take a look at the takeaway points from the COB guidelines.  

  • The primary plan needs to pay or provide its benefits as if the secondary plan or plans don’t exist. It means that the primary payer has to cover your healthcare cost up to the limits first, then the secondary payer will cover the remaining, if any, or pay its share to the maximum limit. 

In most cases, Medicare is the primary payer for individuals who are eligible for Medicare and have other insurance. However, it may vary in some scenarios, which we will discuss below.

  • Both primary and secondary payers are expected to process and pay claims promptly without delaying payments due to COB processing.
  • If there’s a dispute between your Medicare and healthcare insurer, then you can resolve the issue through some means. 

For instance, provide all the necessary documentation to both parties or opt for internal and external reviewing, where a third party reviews the case. However, if the dispute doesn’t end here, you can take legal action as the last resort. 

Now that we’ve discussed the certain COB rules set by the NAIC. Let’s see how Medicare works and coordinates with other insurance companies in different scenarios.  

Medicare COB scenarios – who pays first

In some cases, Medicare acts as a primary payer. While in other cases, it’s a secondary. In either case, there’s a Medicare COB contractor who acts as a referee and reviews the cases, then determines which one is going to pay first (primary) and which one will pay second.

Situations where Medicare pays first

  • If you’re eligible for Medicare and have no other insurance coverage, Medicare is the primary payer for your healthcare services.
  • If you’re suffering from ESRD but have enrolled in Medicare, it will save you quite some money. It will act as a primary payer for the first 30 months of ESRD eligibility.

Note: ESRD is a permanent kidney failure condition and requires ongoing dialysis or a kidney transplant. Without financial assistance, it can cost you an arm and a leg. So enrolling in Medicare would make sense.

  • If you have retiree insurance from the previous job.
  • If you’re 65 or older with employer group health coverage through your or your spouse’s employment , and your or their employer has less than 20 employees, then your Medicare pays first.
  • If you’re 65 and disabled , have group health coverage through your or any family member’s current employment, and that employer has less than 100 employees, your Medicare has the primary responsibility. 
  • If you’re enrolled in Medicare Advantage Plans (Part C) , it’ll pay for your hospital and medical services as a primary payer. However, note that Medicare Advantage plans can have annual updates, so it’s always best to review it annually and contact the provider for any information.
  • If, in addition to Medicare, you’re also enrolled in Federal insurance plans, such as Medicaid or TRICARE, Medicare will pay first. The remaining costs will be covered through the federal plans.

Situations where Medicare pays second

  • If you’re 65 or older with health insurance coverage through your or your spouse’s current employment and the employer has more than 20 employees,
  • If you’re under 65 and disabled, your or your family member’s current employment has your healthcare covered, and the employer has 100 or more employees, 
  • If you go through medical care because of an accident, all the costs will be paid first by your auto insurance and or no-fault insurance,
  • If you’re receiving workers’ compensation benefits that cover health care costs.

For more information about Medicare as a secondary payer, click here to dive deep into the detailed MSP guide .

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How do I update Medicare Coordination of Benefits?

It’s very important to keep your Medicare COB information updated and accurate before your next medical visit. If by chance you haven’t, here’s what you should do.

  • Contact Medicare

First, pick up your phone and contact Medicare directly at 1-800-MEDICARE (1-800-633-4227) and 1-877-486-2048 if you’re a TTY (for the hearing and speech impaired) user. Moreover, you can also visit the website at www.medicare.gov and log in to your Medicare account to make updates or changes.

  • Provide updated information

Next, if any changes occur in your health insurance coverage, including changes to your employer or union coverage, private insurance, or any other type of health coverage you have, inform your Medicare about it. 

  • Fill out the CMS- Coordination of Benefits Form

In exceptional cases, you may also need to fill out a Coordination of Benefits (COB) form provided by your Medicare. The form will collect information about your other insurance plans and help determine which plan pays first. 

  • Review and confirm information

Once you’ve provided all the information and filled out the forms, review them again to ensure all the information is true and accurate. This includes checking the insurance policy, the policyholder’s name (if it’s not you), and any changes in your employment or health insurance status.

After sending the updates their way, make sure to keep follow-ups with your Medicare to confirm that the changes have been processed, and most importantly, your Coordination of Benefits is up-to-date.

  • Stay informed

Once your COB is updated, try to stay informed of any changes that may occur in your insurance plans. Whether you take any new insurance, drop an existing one, or have changes to your current coverage, always keep Medicare on speed dial.

  • Keep records

Last but not least, always keep records of any correspondence, forms, or documents related to your Coordination of benefits. It’s a good practice because you never know when you will find yourself in disputes and legal activities. Your past Medicare documents will come in handy in such dispute cases.

Medicare Coordination of Benefits phone number 

Benefits Coordination & Recovery Center (BCRC): 1-855-798-2627 . For TTY users: 1-855-797-2627 . Apart from holidays, their Customer Service representatives are available from Monday to Friday, 8 AM to 8 PM, Eastern Time.

Medicare Coordination of Benefits Form 

Click here to go to the official site, from where you can download the forms. However, know that Medicare forms and requirements may change over time. 

So, it’s best to go to www.medicare.gov , use the search bar to search for whatever forms you’re looking for, and download the up-to-date version of the form. 

Who is the best person to talk to about Medicare?

If you’re looking for any information regarding Medicare, the best source is their official website. Visit Medicare.gov or contact 1-800-MEDICARE (TTY users: 1-8770486-2048) and ask any questions you have in mind.

Do I still need Medicare if I have health insurance?

If you are near your retirement age and have a health insurance plan through your employer or another source, you may still want to enroll in Medicare, depending on your circumstances. 

For instance, if your or your spouse’s current employer has more than 20 employees and offers healthcare insurance, it pays first for your medical costs. So, in this case, you can choose to delay enrolling in Medicare . 

However, in case the employer has fewer than 20 employees, it’ll be your secondary health coverage. So, it’s advisable to enroll in a primary plan like Medicare.

Who pays first between Medicare and VA benefits?

You can get treatment under both Medicare and Veterans’ benefits programs . However, Medicare is never the secondary payer after the Department of Veterans Affairs (VA). Each time you get any healthcare service or see a doctor, you will choose which program, Medicare or VA benefits, covers the costs. 

Moreover, Medicare can’t pay for the same service that your Veterans’ benefits have covered already, and vice versa. On top of that, if you want to pay through VA benefits, you must go to a VA hospital/ facility or have the VA authorize services in a non-VA facility.

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Coordination of Benefits and Recovery Overview

Guidance for Coordination of Benefits (COB) process that allows for plans that provide health and/or prescription coverage for a person with Medicare to determine their respective payment responsibilities.

Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: June 30, 2020

Coordination of benefits (COB) allows plans that provide health and/or prescription coverage for a person with Medicare to determine their respective payment responsibilities (i.e., determine which insurance plan has the primary payment responsibility and the extent to which the other plans will contribute when an individual is covered by more than one plan).  

The COB Process:

  • Ensures claims are paid correctly by identifying the health benefits available to a Medicare beneficiary, coordinating the payment process, and ensuring that the primary payer, whether Medicare or other insurance, pays first.
  • Shares Medicare eligibility data with other payers and transmits Medicare-paid claims to supplemental insurers for secondary payment. Note: An agreement must be in place between the Benefits Coordination & Recovery Center (BCRC) and private insurance companies for the BCRC to automatically cross over claims. In the absence of an agreement, the person with Medicare is required to coordinate secondary or supplemental payment of benefits with any other insurers he or she may have in addition to Medicare.
  • Ensures that the amount paid by plans in dual coverage situations does not exceed 100% of the total claim, to avoid duplicate payments.
  • Accommodates all of the coordination needs of the Part D benefit. The COB process provides the True Out of Pocket (TrOOP) Facilitation Contractor and Part D Plans with the secondary, non-Medicare prescription drug coverage that it must have to facilitate payer determinations and the accurate calculation of the TrOOP expenses of beneficiaries; and allowing employers to easily participate in the Retire Drug Subsidy (RDS) program. Please click the Coordinating Prescription Drug Benefits link for additional information.

COB Data Sources

COB relies on many databases maintained by multiple stakeholders including federal and state programs, plans that offer health insurance and/or prescription coverage, pharmacy networks, and a variety of assistance programs available for special situations or conditions. Some of the methods used to obtain COB information are listed below:

Voluntary Data Sharing Agreements (VDSAs) - CMS has entered into VDSAs with numerous large employers. These agreements allow employers and CMS to send and receive group health plan enrollment information electronically. Where discrepancies occur in the VDSAs, employers can provide enrollment/disenrollment documentation. The VDSA data exchange process has been revised to include Part D information, enabling VDSA partners to submit records with prescription drug coverage be it primary or secondary to Part D. Employers with VDSAs can use the VDSA to submit their retiree prescription drug coverage population which supports the CMS mission of a single point of contact for entities coordinating with Medicare. Please click the Voluntary Data Sharing Agreements link for additional information.

COB Agreement (COBA) Program - CMS consolidates the Medicare paid claim crossover process through the COBA program. The COBA program established a national standard contract between the BCRC and other health insurance organizations for transmitting enrollee eligibility data and Medicare paid claims data. This means that Medigap plans, Part D plans, employer supplemental plans, self-insured plans, the Department of Defense, title XIX state Medicaid agencies, and others rely on a national repository of information with unique identifiers to receive Medicare paid claims data for the purpose of calculating their secondary payment. The COBA data exchange processes have been revised to include prescription drug coverage.

Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) – This law added mandatory reporting requirements for Group Health Plan (GHP) arrangements and for liability insurance, including self-insurance, no-fault insurance, and workers' compensation. Insurers are legally required to provide information.

Other Data Exchanges - CMS has developed data exchanges for entities that have not coordinated benefits with Medicare before, including Pharmaceutical Benefit Managers (PBMs), State Pharmaceutical Assistance Programs (SPAPs), and other prescription drug payers. CMS has worked with these new partners to educate them about coordination needs, to inform CMS about how the prescription drug benefit world works today, and to develop data exchanges that allow all parties to efficiently serve our mutual customer, the beneficiary.

COB Entities

Benefits Coordination & Recovery Center (BCRC) - The BCRC consolidates the activities that support the collection, management, and reporting of other insurance coverage for beneficiaries. The BCRC takes actions to identify the health benefits available to a beneficiary and coordinates the payment process to prevent mistaken payment of Medicare benefits. The BCRC does not process claims, nor does it handle any GHP related mistaken payment recoveries or claims specific inquiries. The Medicare Administrative Contractors (MACs), Intermediaries and Carriers are responsible for processing claims submitted for primary or secondary payment.

The BCRC is responsible for the following activities:

  • Initiating an investigation when it learns that a person has other insurance. The investigation determines whether Medicare or the other insurance has primary responsibility for meeting the beneficiary's health care costs.
  • Collecting information on Employer Group Health Plans and non-group health plans (liability insurance (including self-insurance), no-fault insurance and workers’ compensation), and updating this information on Medicare databases every time a change is made to insurance coverage. Information comes from these sources:  beneficiary, doctor/provider of service, employer, GHP, liability, no-fault and workers’ compensation entity, and attorney.
  • Establishing MSP occurrence records on CWF to keep Medicare from paying when another party should pay first. The CWF is a single data source for fiscal intermediaries and carriers to verify beneficiary eligibility and conduct prepayment review and approval of claims from a national perspective. It is the only place in the fee for service claims processing system where full individual beneficiary information is housed.
  • Transmitting other health insurance data to the Medicare Beneficiary Database (MBD) for the proper coordination of Rx benefits.
  • Recovery of Non-Group Health Plan (NGHP) related mistaken payments where the beneficiary must repay Medicare. Please see the Non-Group Health Plan Recovery page for additional information.

Once the BCRC has completed its initial MSP development activities, it will notify the Commercial Repayment Center (CRC) regarding GHP MSP occurrences and NGHP MSP occurrences where a liability insurer (including a self-insured entity), no-fault insurer or workers’ compensation entity is the identified debtor. The BCRC will maintain responsibility for NGHP MSP occurrences where Medicare is seeking reimbursement from the beneficiary.   

When to contact the BCRC:

  • To report employment changes, or any other insurance coverage information.
  • To report a liability, auto/no-fault, or workers’ compensation case.
  • To ask a general MSP question.
  • To ask a question regarding the MSP letters and questionnaires (i.e. Secondary Claim Development (SCD) questionnaire.) For more information, click the Reporting Other Health Insurance link.

Please see the Contacts page for the BCRC’s telephone numbers and mailing address information.

Commercial Repayment Center (CRC) – The CRC is responsible for all the functions and workloads related to GHP MSP recovery with the exception of provider, physician, or other supplier recovery. The CRC is responsible for identifying and recovering Medicare mistaken payments where a GHP has primary payment responsibility. Some of these responsibilities include: issuing a Primary Payment Notice (PPN) to verify MSP information, issuing recovery demand letters when mistaken primary payments are identified, receiving payments, resolving outstanding debts, and referring delinquent debt to the Department of Treasury for further collection actions, including the Treasury Offset Program, as appropriate. Please see the Group Health Plan Recovery page for additional information.

The CRC will also perform NGHP recovery where a liability insurer (including a self-insured entity), no-fault insurer or workers’ compensation entity is the identified debtor. Please see the Non-Group Health Plan Recovery page for additional information.

Medicare Administrative Contractors (MACs) – A/B MACs and Durable Medical Equipment Medicare Administrative Contractors (DME MACs) are responsible for processing Medicare Fee-For-Service claims submitted for primary or secondary payment. These entities help ensure that claims are paid correctly when Medicare is the secondary payer. They use information on the claim form, electronic or hardcopy, and in the CMS data systems to avoid making primary payments in error. Where CMS systems indicate that other insurance is primary to Medicare, Medicare will not pay the claim as a primary payer and will deny the claim and advise the provider of service to bill the proper party.

HHS is committed to making its websites and documents accessible to the widest possible audience, including individuals with disabilities. We are in the process of retroactively making some documents accessible. If you need assistance accessing an accessible version of this document, please reach out to the [email protected] .

DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.

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  • Description
  • Learning Objectives

Coordination of benefits is the term used to describe how Medicare works with other kinds of insurance, including employer insurance and Medicaid. In this course, you will learn about the coordination of benefits rules for current and former employer coverage, including COBRA, retiree coverage, and Federal Employee Health Benefits (FEHB). You will find out if Medicare pays primary or secondary to different employer-related insurance, depending on the number of employees and whether individuals are eligible for Medicare due to age or disability. You will also gain valuable knowledge about various enrollment-related consequences and considerations for beneficiaries who delay their Medicare enrollment.

After taking this course, you will be able to:

  • Explain what coordination of benefits means and differentiate between primary and secondary insurance
  • Determine when a beneficiary’s current employer insurance pays primary or secondary to Medicare
  • Understand how COBRA insurance, retiree insurance, and Federal Employee Health Benefits (FEHB) coordinate with Medicare
  • Discuss the consequences of a beneficiary delaying Medicare enrollment

This course contains the following features:

  • Interactive activities and knowledge quizzes
  • Automatic course bookmarking so learners can continue where they left off
  • Review tests at the end of every course – 80% or higher mark to pass the course and download a certificate of completion
  • Educational content vetted by a team of national experts at  Medicare  Rights Center
  • Closed captioning
  • An array of printable supplementary tools and fliers

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Coalition Holds Congressional Briefing on Medicare Coverage for Substance Use Disorder Care.Substring(0, maxlength)

Coalition holds congressional briefing on medicare coverage for substance use disorder care.

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The American Society of Addiction Medicine, the Legal Action Center (LAC), the National Council for Mental Wellbeing, the Illinois Association for Behavioral Health, and the National Association of Social Workers held a briefing on Medicare coverage for substance use disorder (SUD) care on February 15th, 2024, in coordination with the Addiction, Treatment, and Recovery (ATR) Caucus, and sponsored by the Coalition for Whole Health and the Mental Health Liaison Group. 

There are  at least four million adults over the age of 65 with SUD  in the U.S., while  drug overdose deaths among older adults have more than quadrupled over the past two decades .   Representative Paul Tonko (NY-20) of the ATR Caucus highlighted the event and said, "“Far too many of our family, friends, and neighbors struggling with the disease of addiction do not receive the treatment they need. We can and must do better for our community and for our loved ones. We must combat cruelty with compassion and work to ensure that everyone in need of SUD treatment has access to it."

Paul Samuels, President and Director, and Deborah Steinberg, Senior Health Policy Attorney, LAC, moderated the event. Steinberg said "to make treatment truly affordable and accessible and to decrease the stigma around SUD and mental health conditions, it is necessary to fix Medicare's coverage gaps, so such conditions have the same level of insurance coverage as medical conditions.” Steinberg further noted, “removing the discriminatory barriers for SUD and mental health treatment is the meaning of equitable insurance coverage, or parity -- to address this epidemic, we must ensure older adults and people with chronic disabilities have access to non-discriminatory SUD care." 

Panelists' remarks included: 

  • Dr. Corey Waller, Editor in Chief of the ASAM Criteria , who pointed out that in addition to the lack of parity in Medicare, it fails to cover all of the evidence-based services that are reasonable and necessary for the treatment of SUD. Dr. Waller described the full continuum of SUD care that Medicare must cover for beneficiaries to receive their needed and appropriate level of care, and noted this will ultimately help America save in costs from unnecessary and costly emergency department visits and hospitalizations.  
  • Ms. Kelly Epperson, Chief of Staff and General Counsel for Rosecrance in IL , spoke about the residential level of care for SUD treatment that is still not covered by Medicare, despite the many residential treatment providers that deliver evidence-based addiction and mental health treatment across the country. 
  • Additionally, Medicare does not cover all of the community-based settings for SUD care, including specialty community-based SUD treatment facilities and certified community behavioral health clinics (CCBHCs).  Ms. Natalie Cook, Vice President of CLIVE Solutions, representing the Missouri Behavioral Health Council , highlighted the need for Medicare to cover some such settings that provide comprehensive addiction treatment. 
  • Finally, Ms. Catherine Lawder, a licensed clinical social worker from Virginia,  described how rules for Medicare coverage limit the scope of how social workers can treat Medicare beneficiaries, and pay discriminatorily low rates for such workers compared to other medical providers, exacerbating America's mental health and SUD workforce crisis.

Access photographs of the briefing here.

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Provider Services

Coordination of benefits overview.

The Benefits Coordination & Recovery Center (BCRC) consolidates the activities that support the collection, management, and reporting of other insurance coverage for Medicare beneficiaries. The purpose of the COB program is to identify the health benefits available to a Medicare beneficiary and to coordinate the payment process to prevent mistaken Medicare payment. The BCRC does not process claims or claim-specific inquiries. The Medicare Administrative Contractors, (MACs), intermediaries, and carriers are responsible for processing claims submitted for primary or secondary payment and resolving situations where a provider receives a mistaken payment of Medicare benefits.

All Medicare Secondary Payer (MSP) claims investigations are initiated from and researched by the BCRC, and is not a function of the local Medicare claims paying office. This single-source development approach greatly reduces the number of duplicate MSP investigations. This also offers a centralized, one-stop customer service approach for all MSP-related inquiries, including those seeking general MSP information. The BCRC provides customer service to all callers from any source, including, but not limited to, beneficiaries, attorneys/other beneficiary representatives, employers, insurers, providers, and suppliers.

Information Gathering

Medicare generally uses the term Medicare Secondary Payer or "MSP" when the Medicare program is not responsible for paying a claim first. The BCRC uses a variety of methods and programs to identify situations in which Medicare beneficiaries have other health insurance that is primary to Medicare. For example, information submitted on a medical claim or from other sources may result in an MSP claims investigation that involves the collection of data on other health insurance. In such situations, the other health plan may have the legal obligation to meet the beneficiary's health care expenses first before Medicare. For more information about Medicare Secondary Payer and the providers’ role in collecting data to ensure they are billing the correct primary payer, please see the Medicare Secondary Payer Fact Sheet (PDF) .

Provider Requests and Questions Regarding Claims Payment

MACs, intermediaries, and carriers will continue to process claims submitted for primary or secondary payment. Claims processing is not a function of the BCRC. Questions concerning how to bill for payment (e.g., value codes, occurrence codes) should continue to be directed to your local Medicare claims paying office. In addition, continue to return inappropriate Medicare payments to the local Medicare claims office; checks should not be sent to the BCRC. Questions regarding Medicare claim or service denials and adjustments should continue to be directed to your local Medicare claims office. If a provider submits a claim on behalf of a beneficiary and there is an indication of MSP, but not sufficient information to disprove the existence of MSP, the claim will be investigated by the BCRC. This investigation will be performed with the provider or supplier that submitted the claim. The goal of MSP information gathering and investigation is to identify MSP situations quickly and accurately, thus ensuring correct primary and secondary payments by the responsible party.

Medicare Secondary Payer Records in CMS's Database

The BCRC is the sole authority to ensure the accuracy and integrity of the MSP information contained in CMS's database (i.e., Common Working File (CWF)). Information received because of MSP data gathering and investigation is stored on the CWF. MSP data may be updated, as necessary, based on additional information received from external parties (e.g., beneficiaries, providers, attorneys, third party payers). Beneficiary, spouse and/or family member changes in employment, reporting of an accident, illness, or injury, Federal program coverage changes, or any other insurance coverage information should be reported directly to the BCRC.  CMS also relies on providers and suppliers to ask their Medicare patients about the presence of other primary health care coverage, and to report this information when filing claims with the Medicare program.

Termination and Deletion of MSP Records in CMS's Database

Medicare claims paying offices can terminate records on the CWF when the provider has received information that MSP no longer applies (e.g., cessation of employment, exhaustion of benefits). Termination requests should be directed to your Medicare claims payment office. MSP records that you have identified as invalid are reported to the BCRC for investigation and deletion.

Contacting the BCRC

The BCRC’s trained staff will help you with your COB questions. Whether you need a question answered or assistance completing a questionnaire, the Customer Service Representatives are available to provide you with quality service. Click the  Contacts  link for BCRC contact information.

In order to better serve you, please have the following information available when you call:

  • Your Medicare provider number (UPIN/OSCAR/NSC) and provider name. If you cannot furnish a provider number that matches the BCRC’s database, you will be asked to submit your request in writing. 
  • Prior to releasing any Private Health Information about a beneficiary, you will need the beneficiary's full name, and Medicare Number or Social Security Number (SSN). If you are unable to provide the correct information, the BCRC cannot release any beneficiary specific information. You will be advised that the beneficiary's information is protected under the Privacy Act, and the BCRC will not release the information. The BCRC will only provide answers to general COB or MSP questions. For more information on the BCRC, click the  Coordination of Benefits  link.

Contacting the Medicare Claims Office

Contact your local Medicare Claims Office 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.

COBA Trading Partner Contact Information

The Coordination of Benefits Agreement (COBA) Program establishes a nationally standard contract between CMS and other health insurance organizations that defines the criteria for transmitting enrollee eligibility data and Medicare adjudicated claim data. CMS has provided a COBA Trading Partners customer service contact list as an avenue for providers to contact the trading partners. The COBA Trading Partners document in the Download section below provides a list of automatic crossover trading partners in production, their identification number, and customer contact name and number. For additional information, click the COBA Trading Partners link.

MLN Matters Articles - Provider Education

The Medicare Learning Network (MLN) is a CMS initiative to ensure Medicare physicians, providers and supplies have immediate access to Medicare coverage and reimbursement rules in a brief, accurate, and easy to understand format. To access MLN Matters articles, click on the  MLN Matters link.

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  2. 50 Expert Tips for Mastering Medicare Benefits Coordination 2023

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  4. How Medicare Works with Your Medical Benefits

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COMMENTS

  1. Coordination of Benefits

    Coordination of benefits (COB) allows plans that provide health and/or prescription coverage for a person with Medicare to determine their respective payment responsibilities (i.e., determine which insurance plan has the primary payment responsibility and the extent to which the other plans will contribute when an individual is covered by more t...

  2. PDF Coordination of Benefits.

    Coordination of Benefits. Tell Medicare if your other health or drug coverage changes Let the Benefits Coordination & Recovery Center know: Your name Your health or drug plan's name and address Your health or drug plan's policy number

  3. Coordination of Benefits & Recovery Overview

    If a beneficiary has Medicare and other health insurance, Coordination of Benefits (COB) rules decide which entity pays first. There are a variety of methods and programs used to identify situations in which Medicare beneficiaries have other insurance that is primary to Medicare.

  4. PDF Your guide to who pays first.

    Coordination of benefits If you have Medicare and other health coverage, you may have questions about how Medicare works with your other insurance and who pays your bills first . Each type of coverage is called a "payer ." When there's more than one payer, "coordination of benefits" rules decide who pays first .

  5. PDF FAQs: Coordination of Benefits with Medicare

    Coordination of benefits is a process for determining which plan or insurance policy will pay first if 2 or more health plans or insurance policies cover the same benefits. When one of the plans is a Medicare health plan, federal law decides who pays first.

  6. Medicare Coordination of Benefits

    Coordination of benefits (COB) sets the rules for which one pays first when you receive health care. Primary and Secondary Payers The insurer that pays first is called the primary payer. It pays the costs up to the limit of your coverage under that plan. The insurer that pays second is called the secondary payer.

  7. How To Fix Medicare Coordination Of Benefits Issues

    What you need to is call the Medicare Benefits Coordination & Recovery Center at (855) 798-2627. Explain to the representative that your claims are being denied, because Medicare thinks another plan is primary (your previous health insurance). The representative will ask you a series of questions to get the information updated in their systems.

  8. Medicare Coordination of Benefits Rules

    Medicare Coordination of Benefits phone number. Benefits Coordination & Recovery Center (BCRC): 1-855-798-2627. For TTY users: 1-855-797-2627. Apart from holidays, their Customer Service representatives are available from Monday to Friday, 8 AM to 8 PM, Eastern Time.

  9. Login Page

    The collection of this information is authorized by Section 1862 (b) of the Social Security Act (codified at 42 U.S.C 1395y (b)) (see also 42, C.F.R. 411.24). The information collected will be used to identify and recover past conditional and mistaken Medicare primary payments and to prevent Medicare from making mistaken payments in the future ...

  10. Coordination of Benefits and Recovery Overview

    Guidance for Coordination of Benefits (COB) process that allows for plans that provide health and/or prescription coverage for a person with Medicare to determine their respective payment responsibilities. Issued by: Centers for Medicare & Medicaid Services (CMS) June 30, 2020

  11. Course 1: Medicare and Employer Insurance

    Coordination of benefits is the term used to describe how Medicare works with other kinds of insurance, including employer insurance and Medicaid. In this course, you will learn about the coordination of benefits rules for current and former employer coverage, including COBRA, retiree coverage, and Federal Employee Health Benefits (FEHB).

  12. Medicare phone number: Speaking to a person at Medicare

    They can also enroll in Medicare or check Medicare eligibility. Benefits Coordination and Recovery Center. Contact phone numbers for the Benefits Coordination and Recovery Center include 855-798 ...

  13. PDF Coordination of Benefits.

    Coordination of Benefits. Tell Medicare if your other health or drug coverage changes Let the Benefits Coordination & Recovery Center (BCRC) know: Your name The name and address of your plan Your policy number

  14. Contacts

    Coordination of benefits & recovery Overview Contacts Contacts Contacts Note: Submit all payments, forms, documents and/or correspondence to the return mailing address indicated on recovery correspondence you have received. Otherwise, refer to the contact information provided on this page.

  15. Coordination of benefits and Medicare crossovers

    Coordination of benefits (COB) COB is our process for ensuring that our members receive full benefits and helping to prevent over-payment for services when a member has coverage from two or more sources. Blue Cross follows NAIC (National Association of Insurance Commissioner) and CMS (Centers for Medicare and Medicaid Services) guidelines.

  16. Medicare Coordination of Benefits (COB)

    If your benefits change, you should call the Benefits Coordination & Recovery Center at 1-855-798-2627 to update your information. Coordination of benefits refers to what order your health insurance policies pay for services. Find out how Medicare COB works in a variety of scenarios.

  17. Coordination of Benefits

    Billing Medicare Secondary Payer (MSP) Electronically using PC-ACE Pro32; Verify patient's eligibility via Interactive Voice Response (IVR) or the Noridian Medicare Portal. If there is a problem with file, patient may contact Benefits Coordination & Recovery Center (BCRC) at 1-855-798-2627 to make necessary corrections

  18. Guide to Medicare Coverage and Enrollment for Veterans

    Coordination of benefits. If you're a Veteran, you can get comprehensive coverage by combining both Medicare and VA healthcare benefits, plus TRICARE if you're eligible.

  19. Coordination of Medicare and FEHB Benefits

    Medicare law and regulations determine whether Medicare or FEHB is primary (that is, pays benefits first). Medicare automatically transfers claims information to your FEHB plan once your claim is processed, so you generally don't need to file a claim with both. You will receive an Explanation of Benefits (EOB) from your FEHB plan and an EOB or ...

  20. Medicare Flex Card: What It Is and How to Get One

    Medicare flex cards, offered by some Medicare Advantage plans, can help you pay for services and products, such as over-the-counter medications, glasses and hearing aids.

  21. Coordination of Benefits

    The purpose of the coordination of benefits (COB) program is to identify the health benefits available to a Medicare beneficiary and to coordinate the payment process to prevent mistaken payment of Medicare benefits. The BCRC does not process claims or claim-specific inquiries.

  22. DLA Piper

    The FAQ continues to reflect CMS's policy that MAOs may use prior authorization in the context of supplemental benefits (which are not Medicare "basic benefits" covered by Medicare Parts A and B). Given the nature of supplemental benefits, CMS expects MAOs to apply a "clinically appropriate" standard as opposed to "medically ...

  23. Federal Register :: Medicare and Medicaid Programs; Patient Protection

    For example, Medicare Advantage Prescription Drug (MA-PD) plans that cover Part A, Part B, and Part D benefits, as well as supplemental benefits, are required to provide access to information about all those covered benefits through the Patient Access API at 42 CFR 422.119(b). Prescription and other drug information is part of a patient's ...

  24. PDF Federal Employees Health Benefits and Postal Service Health Benefits

    I. FEHB and PSHB Coordination with Medicare . All Carriers must implement a multi-pronged educational outreach effort to eligible enrollees focused on Medicare coordination, including the potential effects of the Income Related Monthly Adjustment Amount (IRMAA). In addition to outbound member communication and education, OPM expects

  25. Forms, Publications, & Mailings

    Get Medicare forms for different situations, like filing a claim or appealing a coverage decision. Find Forms Publications Read, print, or order free Medicare publications in a variety of formats. Get Publications Mailings Find out what to do with Medicare information you get in the mail. ...

  26. Coalition Holds Congressional Briefing on Medicare Coverage for

    The American Society of Addiction Medicine, the Legal Action Center (LAC), the National Council for Mental Wellbeing, the Illinois Association for Behavioral Health, and the National Association of Social Workers held a briefing on Medicare coverage for substance use disorder (SUD) care on February 15th, 2024, in coordination with the Addiction, Treatment, and Recovery (ATR) Caucus, and ...

  27. Provider Services

    The Benefits Coordination & Recovery Center (BCRC) consolidates the activities that support the collection, management, and reporting of other insurance coverage for Medicare beneficiaries.

  28. PDF 1 Executive Summary to The 2023 Financial Report of The U.s. Government

    The Financial Report is produced by Treasury in coordination with OMB, which is part of the Executive Office of the President. ... cost yields the federal government's "bottom line" net operating cost of $3.4 trillion referenced above. ... Medicare and Medicaid benefits programs largely associated with increasing benefits payments. This