Coordination of Benefits and You

Employers must provide the Centers for Medicare & Medicaid Services (CMS) with information regarding health coverage of their Medicare-eligible workers and spouses of Medicare-eligible individuals whenever CMS identifies those individuals to the employer. This process, the IRS/SSA/CMS Data Match, is used to identify situations where another payer may be primary to Medicare. The Data Match process helps Medicare intermediaries and carriers identify claims on an ongoing basis for which Medicare should not be the primary payer.

The Coordination of Benefits (COB) program wants to make sure Medicare pays your employees' claims right the first time, every time. By completing the Data Match, you help to ensure that your employees' records are correct.

If you are looking for ways to streamline your organization's processing of Data Match information and ensure your employees' records are up-to-date, it's time you executed a Voluntary Data Sharing Agreement. Voluntary Data Sharing Agreements ensure that employees' records are updated every time a change is made to their health care coverage. By participating in the Employer Voluntary Data Sharing Agreement program, you keep your employees' Medicare records up-to-date and help reduce your administrative costs.

MSP and Your Employees

Medicare Secondary Payer (MSP) is the payment principle that notes conditions and situations under which Medicare should pay as secondary to some other entity for health services. If employees have other insurance or coverage that must pay before Medicare pays, they need to notify the COB Contractor and their providers of service. They also need to provide an update to the COB Contractor and their medical care providers whenever they have any changes in health insurance. Changes in employment, including retirement, and changes in health insurance companies may affect their claim payments. In addition, employees need to contact the COB Contractor if they are involved in an accident or a workers' compensation case where other insurance covers their injury or where they are suing another entity for medical expenses. By notifying the COB Contractor of insurance coverage changes, employees make sure that their bills are sent to the right payer to avoid delays. The COB Contractor determines, based on the employees' coverage information on file, if the other health coverage must pay before Medicare. By reporting other insurance coverage, the COB Contractor will coordinate payment and may help reduce your employees' out-of-pocket expenses.

Coordination of Benefits and You Fact Sheets

The Medicare Coordination of Benefits (COB) program wants to make sure Medicare pays your claims right the first time, every time. We collect information on your health care coverage and store it in your Medicare record. This record must be updated every time you make a change to your health care coverage. Information comes from these sources:

  • Your Initial Enrollment Questionnaire (IEQ),
  • Your doctor and other providers,
  • Your group health plan,
  • Your employer, and
  • You.

You can help keep your Medicare record up to date. Let your doctor and other providers know about insurance changes so that they can pass them along to Medicare. Medicare will use this information to determine who should pay your claims first. This will speed up and improve the payment process.

Medicare may be your secondary payer. Your record should show whether a group health plan or other insurer should pay before Medicare. Paying claims right the first time prevents mistakes and problems with your health care plans.

If you have general questions about Medicare Coordination of Benefits, contact the COB Contractor's Customer Service Department using our toll-free lines: 1-800-999-1118 or TTY/TDD: 1-800-318-8782 for the hearing and speech impaired. Our representatives are available to assist you Monday through Friday, from 8:00 a.m. to 8:00 p.m., Eastern Time, except holidays.

For more information on how MSP affects your employees, see below for the beneficiary Coordination of Benefits & You Fact Sheet.