Coordination of Benefits Agreement (COBA) Detailed Error Report Notification Process
Through the national COBA process, Medicare will automatically cross claims over to a supplemental payer/insurer that may pay after Medicare has made its payment decision on the claim. There may be situations (such as claim errors related to HIPAA) that prevent Medicare from crossing a claim over to the supplemental payer/insurer.
In those situations where Medicare is unable to cross the claim, CR 3709 directs Medicare Contractors to issue special automated correspondence to notify physicians, suppliers, and providers when claims previously selected for crossover by Medicare were subsequently unable to be crossed to the supplemental payer/insurer.
The correspondence sent to the physician, supplier, or provider will contain specific claim information, including the Internal Control Number (ICN)/Document Control Number (DCN), Health Insurance Claim (HIC) number, Medical Record Number (if the letter is from an intermediary and the claim was for Part A services), Patient Control Number (if present on the claim), beneficiary name, date of service, the date the claim was processed, an error code, and an error description. In addition, the letter will include the following message:
“The above claim(s) was/were not crossed over to the patient’s supplemental insurer due to claim data errors.” Upon receipt of such correspondence, the physician, supplier, or provider is advised that the claim is not being crossed automatically and the provider may take appropriate action to obtain payment from the supplemental payer/insurer.
If you have any question regarding your error description, what it means, or how to handle it, please contact your billing vendor.
Additional Information
Complete details of the COBA Error Notification process are included in the official instruction issued to your carrier/DMERC/intermediary. That instruction may be viewed at: http://www.cms.hhs.gov/Transmittals/. Once this site is accessed, look for CR 3709 in the CR NUM column on the right, and click on the file for that CR.
Page Last Updated: Wednesday, 31-Dec-2008 10:49:01 CST
