Family Care to receive Coordination of Benefits Agreement (COBA) Medicare Part A and Medicare Part B Electronic Crossover Claims:
The Centers for Medicare and Medicaid Services (CMS) has published final regulation requiring Family Care managed care organizations (MCOs) to enter into a national Coordination of Benefits Agreement (COBA) for Medicare Part A and Medicare Part B crossover claims. CMS requires compliance with this regulation on October 1, 2020 for Family Care MCOs.
COBA Medicare Crossover Facts:
- Each Family Care MCO has agreed to be a COBA trading partner with CMS.
- On October 5, 2020 all Family Care MCOs’ member eligibility will be sent to CMS. CMS will then automatically send electronic claims, regardless of the date of service, to WPS for Medicare-enrolled members for Medicare-covered services.
- WPS will only accept and process Family Care covered services based on Family Care covered CPT-4, HCPCS and Revenue codes. Non Family Care covered codes will NOT be processed.
- The provider’s Medicare Remittance Advice will indicate that the claim was automatically crossed over to one of the Family Care MCO’s (indications such as “MA18” or Claim information forwarded to:). When the crossed over notice appears on the Medicare Remittance Advice, providers will NOT need to submit paper claims with the Medicare Explanation of Benefits (EOMB) to WPS.
- The following are cases when providers must continue to submit paper claims along with the paper EOMB to WPS:
- The automatic crossover claim is denied by WPS and additional information is required to allow payment (such as Auth #, proper dates of service, service codes, etc.)
- The claim is for a member who is enrolled in Medicare and has commercial health insurance which is secondary to Medicare (e.g., Medicare Supplemental)
- The claim is for a member who was not enrolled in Family Care at the time the service was submitted to Medicare for payment, but the member was retroactively determined enrolled in Family Care
- The claim is for a member who is enrolled in a Medicare Advantage Plan or Medicare Cost Plan
- Medicare adjusted claim
- WPS corrected claim form
- When the Provider’s Medicare Remittance Advice does NOT indicate that the claim was crossed over (indications such as “MA18” or Claim information forwarded to: )
The COBA Medicare Crossover process is a value added feature for Family Care providers and will speed up payment and reduce provider administration costs.
Please direct any questions to the WPS Family Care Contact Center phone number: 1-800-223-6016.