Coordination of Benefits & Recovery Overview

 

Additional Web pages available under the Coordination of Benefits & Recovery section of CMS.gov can be found in the Related Links section below.

The Medicare Secondary Payer (MSP) program is in place to ensure that Medicare is aware of situations where it should not be the primary, or first, payer of claims. If a beneficiary has Medicare and other health insurance, Coordination of Benefits (COB) rules decide which entity pays first. There are a variety of methods and programs used to identify situations in which Medicare beneficiaries have other insurance that is primary to Medicare. Activities related to the collection, management, and reporting of other insurance coverage for beneficiaries is performed by the Benefits Coordination & Recovery Center (BCRC).

In certain situations, after a Medicare claim is paid, CMS receives new information indicating Medicare has made a primary payment by mistake. Based on this new information, CMS takes action to recover the mistaken Medicare payment. The BCRC is responsible for the recovery of mistaken liability, no-fault, and workers’ compensation (collectively referred to as Non-Group Health Plan or NGHP) claims where the beneficiary must repay Medicare. If it has been determined that a Group Health Plan (GHP) is the proper primary payer, the Commercial Repayment Center (CRC) will seek recovery from the Employer and GHP. The CRC is also responsible for recovery of mistaken NGHP claims where a liability insurer (including a self-insured entity), no-fault insurer or workers’ compensation entity is the identified debtor. Together, the BCRC and CRC comprise all Coordination of Benefits & Recovery (COB&R) activities. The most current contact information can be found on the Contacts page. Additional information regarding the MSP program as well as COB and recovery activities can be found in the menu to the left. 

CMS has made available computer-based training courses (CBTs), flowcharts, presentations and other informational material to assist you in understanding COB&R. It is recommended you always scroll to the bottom of each Web page to see if additional information and resources are available for access or download.

How to sign-up for Coordination of Benefits & Recovery Overview Web page updates

CMS provides the ability for you to be notified when announcements or new information is posted on the Coordination of Benefits & Recovery web pages. If you have not already signed up for these notifications, please enter your e-mail address in the “Receive E-Mail Updates” box at the bottom of any CMS.gov web page and select which pages you would like to receive notifications on. When notifications and new information, regarding Coordination of Benefits & Recovery are available, you will be notified at the provided e-mail address.