COORDINATION OF BENEFITS CONTRACTOR (COB)

One initiative of The Centers for Medicare and Medicaid Services (CMS) is to centralize Medicare's Coordination of Benefits activities. On November 1, 1999, CMS awarded the COB contract to Group Health Incorporated (GHI).

The COB contract has consolidated, under a single contractor entity, all of the activities that support the collection, management, and reporting of all other health insurance coverage of Medicare beneficiaries including coverage obligated to pay primary to Medicare. On January 1, 2001, they will assume responsibility for all Medicare Secondary Payer (MSP ) development activities formerly performed by fiscal intermediaries (FIs) and carriers. MSP refers to situations where the Medicare program does not have primary responsibility for paying a beneficiary's health care expenses.

Contact Information:

Effective January 1, 2001, Medicare providers should directly contact the COB contractor regarding all general MSP-related inquiries (that are NOT claim-specific). Their trained Customer Service Representatives are available to provide you with quality service from 8:00 a.m. through 8:00 p.m., EST, Monday through Friday.

Telephone inquiries should be made to the following toll-free
line(s):

1-800-999-1118 or TDD/TTY 1-800-318-8782
Written inquiries should be sent to:

MEDICARE - Coordination of Benefits
P.O. Box 660
New York, NY 10274-0660

COB Contractor's Responsibilities:

The COB Contractor WILL:

• Handle all MSP-related inquiries including general MSP information requests
• Conduct MSP development activities (with providers, beneficiaries and other sources), including first claim, trauma-code, self-report process (42 CFR 411.25) notices, and secondary claims development using a variety of tools to solicit the information such as questionnaires, telephone contacts and data exchanges
• Establish MSP periods of coverage at the Common Working File )CWF) that result from the activities listed above
• Update the Common Working File (CWF) accurately and timely

The COB Contractor WILL NOT:

• Process Claims
• Handles recoveries
• Handle Claim-specific inquiries
• Handle Veteran's Administration (VA) situations

Providers should continue to contact Maryland Medicare Part A on these issues. The COB contractor will be performing all development relating to MSP situations, it is the providers responsibility to respond directly and promptly to the COB contractor development requests.

CMS goals are to provide high-quality and efficient customer service to beneficiaries and advocates, providers, employers, attorneys, and Medicare contractors, while ensuring the integrity of the Medicare Trust Funds. COB plays an integral role in attaining these goals.

The purpose of the COB program is to identify the health benefits available to a Medicare beneficiary and to coordinate the payment process to prevent mistaken payment of the Medicare benefits. Information on eligibility and benefits entitlement is obtained from the COB central file and is used to facilitate accurate payment.

By consolidating performance of similar activities that are necessary to carry out each of the COB functions, cost reductions and management efficiencies will be achieved.

The COB contractor will be in contact with providers in their development processes.