To comply with the Centers for Medicare & Medicaid Services (CMS) Managed Care regulations at Federal Register § 438.3(t), States that use the automated crossover process must require managed care organizations (MCOs) to enter into a Coordination of Benefits Agreement (COBA) with Medicare and be able to accept and process automated crossover claims.
The COBA automatic crossover process allows CMS and the State to use a standardized contract that outlines criteria for the submission of eligibility information and Medicare adjudicated claim data allowing for the coordination of benefits in claims processing.
CMS uses a single-source national crossover contractor, the Benefits Coordination & Recovery Center (BCRC), to handle coordination of crossover data. This entity is also referred to as the Coordination of Benefits Contractor (COBC).
Effective on and after January 1, 2018, all crossover claim files will be sent from the COBC directly to the applicable MCO. The routing of the affected claims will be determined by the member’s assignment dates with the MCO or Kansas Medical Assistance Program (KMAP). Providers will not need to change the way crossover claims are billed. COBC will route the claim to the appropriate payer.
In order to facilitate a seamless transition, KMAP is requesting that providers submit a request to add or update their current Medicare National Provider Identifier (NPI) numbers with KMAP. This will allow claims to process correctly when automatically crossing over from Medicare.
Article reprinted from the KMAP Newsletter.
