Coordination of Benefits Agreement (COBA)

**Replaces Complementary Crossover and Medigap**

The new Coordination of Benefits Agreement (COBA) Program establishes a nationally standard contract between the Centers for Medicare & Medicaid Services (CMS) and other health insurance organizations that defines the criteria for transmitting enrollee eligibility data and Medicare adjudicated claim data. The CMS will transfer the claims crossover functions from individual Medicare contractors to a national claims crossover contractor, the Coordination of Benefits Contractor (COBC).This consolidation will allow for the establishment of unique identifiers (COBA IDs) to be associated with each contract and create a national repository for COBA information.

The COBA crossover consolidation initiative was implemented on a small-scale effective July 6, 2004. On that date, ten COBA trading partners began serving as beta-site testers for the COBA pilot test. During the COBA pilot test, numerous Health Insurance Portability and Accountability Act (HIPAA) ANSI-X12N 837 COB issues were identified and remedied. COBA trading partners will begin testing on a monthly basis. Trading partners are moved to production when testing is complete and they are prepared internally to move to the COBA consolidated claims crossover process.

How the Coordination of Benefits Agreements Works

Through the consolidated claims crossover (or COBA) process, trading partners will no longer need to submit separate eligibility files to CMS' local Medicare contractors to identify their covered members nor will they receive numerous identifiers and crossover claim files or separate invoices from these entities. Trading partners will continue to generate eligibility files using the same format that is currently in effect but updated to include drug coverage information. The COBC will transfer claims to trading partners in the HIPAA ANSI-X12N 837 COB (version 4010-A1) and National Council for Prescription Drug Programs (NCPDP) version 5.1 batch standard 1.1 formats. All eligibility file-based trading partners will be transitioned from their existing crossover agreements with Medicare contractors to national COBAs throughout Fiscal Year (FY) 2005 starting no earlier than April 2005. After transitioning all eligibility file-based trading partners to the consolidated COBA process, CMS' current plan is to also consolidate at a national level the Medigap claim-based crossover process. The Medigap claim-based crossover process became effective October 1, 2007.

Update: Medigap ("Claim-Based") Crossover Process

Effective with October 1, 2007, and as specified in Transmittal 283, CR 5662, physicians and other suppliers that bill using paper forms, i.e., those granted an exception for billing electronically under the Administrative Simplification Compliance Act (ASCA), shall include the newly assigned 5-byte identifier (number will fall in the range 55000 through 59999) within item 9-D of incoming paper CMS-1500 claim forms. These providers should complete items 9A through 9D, in accordance with previous procedures, to ensure they will successfully trigger a Medigap claim-based crossover.

Providers that are required to bill Medicare electronically using the Health Insurance Portability and Accountability Act (HIPAA) American National Standards Institute (ANSI) X12-N 837 professional claim shall include the newly assigned 5-byte only COBA Medigap claim-based ID (range=55000 to 59999) in field NM109 of the NM1 segment within the 2330B loop. Retail pharmacies that bill National Council for Prescription Drug Programs (NCPDP) batch claims to Medicare shall include the newly assigned Medigap identifier within field 301-C1 of the T04 segment of their incoming NCPDP claims.

Medigap Claim Based COBA IDs For Billing Purposes

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