Medigap Crossover Claims

Transitioning the Mandatory Medigap (ÒClaim-BasedÓ) Crossover Process to the Coordination of Benefits Contractor (COBC). CMS is transitioning its mandatory Medigap (Òclaim-basedÓ) crossover process from its Part B contractors to the COBC. During the period from June through September 2007, CMSÕ Coordination of Benefits Contractor (COBC) will sign national crossover agreements with Medigap claim-based crossover insurers and will assign new 5-digit Coordination of Benefits (COBA) Medigap claim-based crossover identifiers to these entities for inclusion on incoming Medicare claims. CMS is also preparing a separate change request (CR 5662) that includes the website where your billing staffs may go to obtain the listing of new COBA Medigap claim-based identifiers for purposes of initiating Medigap claim-based crossovers. October 1, 2007 is the effective date for completing the transition of the Medigap crossover process to the COBC.

• Effective with claims filed to Medicare on October 1, 2007:
• You will need to make certain that claims are submitted with the appropriate identifier that begins with a Ã’5Ó and contains Ã’5Ó numeric digits.
• When the claim submitted to the Medicare contractor indicates that (1) the claim contained an invalid claim-based Medigap crossover ID, the Medicare contractor will send the following standard message to you, the provider.
• Information was not sent to the Medigap insurer due to incorrect/invalid information you submitted concerning the insurer. Please verify your information and submit your secondary claim directly to that insurer.