Claims Crossover

The Coordination of Benefits Agreement (COBA) Medicare claims crossover program establishes a nationally standard contract between CMS and other health insurance organizations. This agreement defines the criteria for transmitting enrollee eligibility data and Medicare-adjudicated claim data to supplemental payers. The Benefits Coordination & Recovery Center (BCRC) serves as the national claims crossover contactor and administers Medicare claims crossover functions on CMS’s behalf.

The COBA Program assigns unique identifiers (COBA IDs) to each contract and payer line of business and maintains a national repository of COBA information. For more information, visit the COBA webpage.

Virtually all standard Medicare supplemental insurance policies or Medigap plans, defined in Section 1882(g)(1) of Title XVIII of the Social Security Act, take part in the automatic or eligibility file-based crossover process. These plans typically accept both institutional and professional Medicare crossover claims on a daily basis.

About 12 Medigap plans use the less common Omnibus Budget Reconciliation Act of 1987 (OBRA 1987) Section 4081 Medigap claim-based crossover process. Unfortunately, this process doesn’t support the crossover of 837 institutional claims, including inpatient, outpatient, home health, and hospice related claims.

In most cases, Medicare automatically crosses over patients’ claims to supplemental insurers, provided those insurers participate in the COBA crossover process.

To learn about the Medicaid Crossover process, select the Medicaid Crossover button.