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The information in this section will serve as a valuable resource for answering your questions about the Coordination of Benefits (COB) program and assisting you with meeting your responsibilities under the Medicare Secondary Payer (MSP) laws. Insurers play a vital role in building and maintaining the integrity of Medicare payments. Under Code of Federal Regulations (CFR) 411.25, insurers are required to notify Medicare if Medicare has made a primary payment for services for which the insurer should have made primary payment. If you do not understand or meet the responsibilities of your role in the MSP process, benefit dollars will be needlessly depleted from the Medicare Trust Funds. A Voluntary Data Sharing Agreement (VDSA) is an effective tool that can help you meet your MSP obligations. A VDSA allows for the electronic data exchange of GHP entitlement and Medicare entitlement information between the Centers for Medicare & Medicaid Services (CMS) and an insurer. The agreement establishes conditions under which the insurer provides CMS with GHP entitlement data on insured individuals, and CMS provides the insurer with Medicare entitlement information for identified Medicare individuals. The parties seek to coordinate health care benefit payments more efficiently in accordance with Medicare Secondary Payer (MSP) and Medicare related laws. The CMS has entered into VDSAs with many insurers as well as numerous Fortune 500 companies and other large employers. A VDSA produces substantial benefits for insurers and their employer customers. This information exchange can streamline the administration of insurance processes, eliminating the need for overpayment negotiations and possible penalties. Such agreements ensure that all insurers involved in benefits payment, including Medicare, pay primary when appropriate. A VDSA also eliminates duplicate payments where Medicare pays the provider or beneficiary and another insurer also pays the provider or beneficiary for the same services. The CMS and the Coordination of Benefits (COB) Contractor have made significant modifications to the existing VDSA program to fit the benefit coordination needs of the new Medicare Part D prescription drug benefit. Employers and Insurers signing VDSAs will also be responsible for reporting prescription drug coverage that is secondary to Medicare Part D for administration of the benefit. The CMS would like to work with you, as partners, to exchange GHP information. The COB Contractor is available for insurer group conferences where the COB Contractor will discuss the VDSA program and other MSP topics. To learn more about insurer group conferences, go to the Insurer Outreach page (link listed below). Effective October 1, 2004, the Centers for Medicare & Medicaid Services (CMS) began implementation of a new and improved way for other health insurers to streamline the current Medicare crossover claims process. Under CMS' consolidated crossover process, trading partners that include Medigap plans, employer supplemental plans, self-insured plans, TRICARE for Life, Title XIX State Medicaid Agencies, and others will no longer have to sign separate agreements with individual Medicare contractors to receive Medicare paid claims data for the purpose of calculating their secondary payment liability. Instead, they will enter into one national Coordination of Benefits Agreements (COBA) with the COB Contractor. To learn more about the new Medicare crossover process, go to the Coordination of Benefits Agreement (COBA) page (link listed below). The CMS has also incorporated information about prescription drugs into the COBA program to accommodate Medicare Part D benefit coordination needs similar to the modifications to the VDSA program. If you are unable to find the information you need, contact us using our toll-free lines: 1-800-999-1118 or TTY/TDD: 1-800-318-8782 for the hearing and speech impaired. A representative will be available to assist you Monday through Friday, from 8:00 a.m. to 8:00 p.m., Eastern Time, except holidays.
Page Last Modified: 12/14/2005 5:11:00 PM
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