The COBA Program Coordinates Benefits between Medicare and Medi-Cal

Date: 01/13/20

After Medicare makes their payment, the claim is automatically sent to CHWP for processing

As a reminder, on April 8, 2018, California Health and Wellness Plan (CHWP) entered into a Coordination of Benefits Agreement (COBA) Program with the Centers for Medicare & Medicaid Services (CMS). This agreement established CHWP as a COBA Trading Partner for the purposes of coordinating benefits for dual eligible members who have traditional Medicare as the primary carrier and Medi-Cal as the secondary carrier.

The COBA program identifies the health benefits available to a Medicare beneficiary and coordinates the payment process to ensure appropriate payment of Medicare benefits. The program offers an automatic crossover¹ service to other insurers, or trading partners, that may pay benefits after the Medicare claim has been processed.

COBA program benefits

CHWP and providers can benefit from the COBA program as follows:

• The COBA program helps ensure claims are processed correctly by coordinating the payment process, ensuring that Medicare pays first then automatically sending to the secondary payer (CHWP) for processing.
• CMS will electronically crossover¹ the claims to CHWP with the member’s eligibility and Medicare explanation of benefits (EOB) information. This will ensure accurate coordination of benefits, speed up claims processing time, and avoid duplicate claims.

How to submit claims for Medicare dual eligible members

• Providers must submit the claim to the Medicare claims address indicated on the member’s Medicare ID card.
• After submission to Medicare, providers do not have to submit their claims to CHWP for secondary processing. The COBA process will automatically send the claim to CHWP for processing.

Additional information

Providers are encouraged to access CHWP’s provider portal online at www.CAHealthWellness.com for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.

If you have questions regarding the information contained in this update, contact CHWP at 1-877-658-0305.          

 

¹Crossover is the transfer of processed claim data from Medicare operations to Medicaid (or state) agencies and private insurance companies that sell supplemental insurance benefits to Medicare beneficiaries.