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Q&A: Trouble with secondary claims


A crossover is done on claims paid by Medicare based on the eligibility information reported.

Q: We are having difficulty with secondary claims going to Medigap insurers and Medicaid. Our explanation of benefits indicates the claims have crossed over, but when we check, the secondary indicates no record of the claim. Can you help us figure out what the problem is?

A: The crossover process changed some time ago. There is a Coordination of Benefits Contractor (COBC) who has the responsibility of the claims-crossover process. Medigap or Medicaid entities share eligibility information with the COBC. Based on the eligibility information reported, a crossover is done on claims paid by Medicare. The Remark Code on the Medicare EOB indicates only that Medicare has crossed the claim to the COBC. It is processed based upon the eligibility information that the COBC has received from the Medigap or Medicaid entity. For a list of crossover companies (excluding Medicaid) currently eligible, go to the CMS website at http://www.cms.hhs.gov/COBAgreement/Downloads/Contacts.pdf.

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