Visit us on the web! For more information on Medicare agreements for service coordination, check our website: www.cms.hhs.gov/cobagreement The latest information on Medigap Claim-based crossovers (continued) – Medigap insurers must be able to: accept residual claims (receivables sent to Part B contractor or to DMAC`s payment floor before October 1, 2007) after October 1, 2007, after October 1, 2007. CMS Medicare contractors will terminate all cross-contracts with Medigap beneficiaries by October 31, 2007. Closing of the survey Please note: If the investigation determines that the claims must not have been exceeded, the claims are designated as Regulation A – Consent. If the investigation finds that the claims have been properly cross-referenced, the claims are designated as R – Refusal. In the absence of sufficient information to deal with the dispute, claims are flagged as an inadequate settlement I. . NPAG Conference, Chicago, IL 25 September 2007 Sherri McQueen, COBC Brian Pabst, CMS Donna Razor, COBC . Welcome to the Coordination of Benefits Agreement (COBA) presentation. The Benefit Coordination Process (COBA) process.

Brian R. Pabst, MPA COBA Medigap Claim crossover news – All Medigap insurers must be able to accept the HIPAA 837 professional application for Medigap for cross-ends from October 1, 2007. Medicare will stop identifying claims for its crossover system based on the claim medigap effective October 1, 2007. CoB Contractor`s Role – Negotiating and Executing COBAs – Receiving and processing authorization files – Receiving and converting in HIPAA format – Transfer of Claim Files to TPs – TP Application File Process – Completion of Billing, Payment and Payment Activities. The Coordination of Benefits Agreement (COBA) Process Brian R. Pabst, MPA COBA Government Leader Starting March 30, 2020, Horizon NJ Health will implement a new disaster system process with the Centers of Medicare and Medicaid Services (CMS) starting March 30, 2020. This optimized method no longer requires you to manually submit Medicare claims to Horizon NJ Health for secondary examination. After March 30, if you file claims with Traditional Medicare, there will be a systemic referral and the claim will be forwarded to Horizon NJ Health for secondary treatment. After CMS has made a decision on the law, Horizon NJ Health will process the claim taking into account all membership fee contribution amounts and all amounts not covered by Medicare.