The Centers for Medicare & Medicaid Services (CMS) has decided that it will not continue to maintain both an eligibility file-based crossover process at all Medicare contractors and the consolidated COBA process at the COBC. Therefore, Medicare contractors may no longer cross claims over to trading partners pursuant to signed crossover agreements and the submission of eligibility files, beyond December 31, 2005. As of that date, the COBC will exclusively cross over all claims to trading partners in the HIPAA ANSI X12-N 837 (Version 4010A1) COB formats via the eligibility file-based COBA process, unless Medicare contractors request specific waivers on behalf of current trading partners. Waivers will be granted on a case-by-case basis and must include a justification for not testing the COBA process with the COBC or why production with the COBA process is not possible by December 31, 2005. If you have adequate justification for not being in production with the COBA consolidated crossover process by December 31, 2005, a Waiver Request must be submitted to Medicare contractors so that they are received no later than December 7, 2005. Requests can be submitted either electronically to patricia.allen@empireblue.com, or by fax at 315-442-4626, or by mail to Empire Medicare Services, Maildrop 4-6, 400 South Salina St., Syracuse, NY 13202-2416. If you have Trading Partner Agreements (TPAs) with multiple Medicare contractors, you only need to complete the attached form for one of the contractors, but Section I. J. of the Waiver Request must include all other Medicare contractors for which you have TPAs, including Part A and Part B TPAs with the same contractor. The December 31, 2005 end date does not apply to mandated Medigap (claim-based) crossover processes maintained by Part B and DMERC contractors. This process will continue at the Part B and DMERC contractors until further notice. Please be certain that you return all three pages of the attached form. |
