Coordination of Benefits Agreement

CMS developed a model national contract, called the Coordination of Benefits Agreement (COBA), which standardizes the way that eligibility and Medicare claims payment information within a claims crossover context is exchanged. COBAs permit other insurers and benefit programs (also known as trading partners) to send eligibility information to CMS and receive Medicare claims data for processing supplemental insurance benefits from CMS’ national crossover contractor, the Benefits Coordination & Recovery Center (BCRC). The BCRC houses COBA trading partner’s eligibility information for crossover purposes only in those instances where the information successfully matches with the in-file CMS entitlement information. COBA trading partners are apprised of situations where their eligibility information matches CMS eligibility data as well as when their submitted information does not result in a match.

The Downloads section, near the bottom of the page, contains the COBA Implementation User Guide, the standard COBA Agreement, the COBA Attachment, and other related documents.  

How a Coordination of Benefits Agreement Works

Trading partners generate an eligibility file to the BCRC using the COBA Eligibility (E-01) Record Layout format. Please visit the COBA File Formats and Connectivity page for additional information. For those beneficiaries listed on the eligibility file, the BCRC will transfer claims to trading partners in the HIPAA American National Standard  Institute (ANSI) Accredited Standard Committee (ASC)-X12 837 COB (versions 5010A1 and 5010A2) and National Council for Prescription Drug Programs (NCPDP) version D.0  batch standard 1.2  formats.

Trading partners that provide drug coverage that pays supplemental to Medicare Part D coverage have the option of reporting this eligibility data to CMS via the COBA E-02 Eligibility File. The Drug Coverage Record Layout may also be downloaded from the COBA File Formats and Connectivity page.

To enroll in the COBA program, contact the BCRC’s Electronic Data Interchange (EDI) Department to discuss COBA service options which will be customized to your organization. The BCRC EDI Department’s contact number is 1-646-458-6740.