Medicare Coordination of Benefits Agreement

In-Use COBA Claim File Formats

The current in-use production claim file formats under the COBA program, in accordance with the transaction & code sets  adopted by the Secretary of Health & Human Services
through a final rule published in 45 CFR 162 during 2003 and within the Federal Register February 20, 2003, are as follows:
American National Standards Institute (ANSI) Accredited Standards Committee (ASC) X12N 837 version 4010A1 institutional claim
ANSI ASC X12N 837 version 4010A1 professional claim
National Council for Prescription Drugs (NCPDP) Version 5.1, Batch Standard 1.1

A transcript of the June 9, 2009 and the June 23, 2009 presentation (Medicaid) of the 5010 and NCPDP COB testing call is available in the download section located near the bottom of this page
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. The CMS has transferred the claims crossover functions from individual Medicare contractors to a national claims crossover contractor, the Coordination of Benefits Contractor (COBC). This consolidation allows for the establishment of unique identifiers (COBA IDs) to be associated with each contract and create a national repository for COBA information.

How the Coordination of Benefits Agreements Works
Trading partners generate eligibility files using the same format that documented on the Eligibility File Format page also included drug coverage information. For those beneficiaries listed on the eligibility file 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.

Enroll in the COBA Program

To get started, simply click on the links at the bottom on the page, and review subsections listed on the left hand column. For additional information about the COBA program, email us at COBVA@EHMEDICARE.COM or contact the COBC at 1-800-999-1118 begin_of_the_skype_highlighting              1-800-999-1118      end_of_the_skype_highlighting or TTY/TDD 1-800-318-8782 begin_of_the_skype_highlighting              1-800-318-8782      end_of_the_skype_highlighting for the hearing and speech impaired, Monday through Friday, from 9:00 a.m. - 5:00 p.m., Eastern Standard Time, except holidays.


No comments:

Top Medicare billing tips