(Medicare Claims Processing Manual)

The RO provides information as to the overall success of the complaint validation and referral procedure including the extent of cooperation among CMS, OIG, State Insurance Departments, and the U.S. Attorneys.  This information will be used to correct or strengthen existing procedures.  This report should be submitted by the 15th of the month following the report quarter.  Transmittals Issued for this Chapter  Rev #  Issue Date  Subject  Impl Date  CR#  R11939CP  04/05/2023  Process Improvements for the National Coordination of Benefits Agreement (COBA) Detailed Error Reporting Notification Process  07/06/2023  13154  R10638CP  03/09/2021  Modernization of the Electronic Files Transfer (EFT) Associated with the National Coordination of Benefits Agreement (COBA) Crossover Process 04/05/2021  12053  R10559CP  01/20/2021  Modernization of the Electronic Files Transfer (EFT) Associated with the National Coordination of Benefits Agreement (COBA) Crossover Process - Rescinded and replaced by Transmittal  10638 04/05/2021  12053  R4281CP  04/19/2019  Update to Chapter 28 in Publication (Pub.) 100-04 to Provide Language-Only Changes for the New Me dicare Card Project  05/20/2019  11261  R4243CP  02/15/2019  Modifications to the National Coordination of Benefits Agreement (COBA) Crossover Process  04/01/2019  10961  R4160CP  11/02/2018  Modifications to the National Coordination of Benefits Agreement (COBA) Crossover Process - Rescin ded and replaced by Transmittal 4243  04/01/2019  10961  R4157CP  11/02/2018  Hospital and Critical Access Hospital (CAH) Swing -Bed Manual Revisions and Shared Systems Changes 04/01/2019  10961  R4069CP  06/08/2018  Alignment of Coordination of Benefits Agreement (COBA) Internet Only Manual References  07/09/2018  10737  R3714CP  02/03/2017  Changes to the National Coordination of Benefits Agreement (COBA) Crossover 07/03/2017  9885  Rev #  Issue Date  Subject  Impl Date  CR#  Process as a Result of the Social Security Number Removal Initiative (SSNRI)  R3004CP  08/01/2014  Modification to the National Coordination of Benefits Agreement (COBA) Crossover Process  01/05/2015  8731 R2906CP  03/14/2014  Pub 100-04, Chapter 28 language-only update for ASC X12 version 5010, implementation of MACs, and MAC coordination with Medigap, Medicaid and Other Complementary Insurers 04/14/2014  8540 R2904CP  03/14/2014  Pub 100-04, Chapter 28 language-only update for ASC X12 version 5010, implementation of MACs, and MAC coordination with Medigap, Medicaid and Other Complementary Insurers 04/14/2014  8540 R2810CP  11/07/2013  Modifications to the National Coordination of Benefits Agreement (COBA) Crossover Process  04/07/2014  8454 R2569CP  10/26/2012  Modifications to the National Coordination of Benefits Agreement (COBA) Crossover Process  04/01/2013  8071 R2215CP  05/13/2011  Modifications to the COBA Process for Other Federal Payer Payment Order and Other Issues  10/03/2011  7393 R2189CP  04/04/2011  Modifications to the National Coordination of Benefits Agreement (COBA) Crossover Process Stemming Principally From the Affordable Care Act (ACA)  04/04/2011  7136 R2181CP  03/25/2011  Medicare Claims Processing Pub. 100-04 Chapter 24 Update for HIPAA 5010 and EDI Enhancements 04/25/2011  7269 R2090CP  11/10/2010  Implementation of Errata for Version 5010 of Health Insurance Portability and 04/04/2011  7202  Rev #  Issue Date  Subject  Impl Date  CR#  Accountability Act (HIPAA) Transactions, and Updates in 837I, 837P, and 835 Flat Files  R2087CP  11/05/2010  Implementation of Errata for Version 5010 of Health Insurance Portability and Accountability Act (HIPAA) Transactions, and Updates in 837I, 837P, and 835 Flat Files  Rescinded and replaced by Transmitta l 2090 04/04/2011  7202 R2076CP  10/28/2010  Modifications to the National Coordination of Benefits Agreement (COBA) Crossover Process  Stemming Principally From the Affordable Care Act (ACA)   Rescinded and replaced by Transmittal 2189 04/04/2011  7136 R1920CP  02/19/2010  Modifications to Gap- Filling Requirements for the Health Insurance Portability Accountability Act (HIPAA) 837 version 5010 Coordination of Benefits (COB) Claims Transactions and National Council for Prescription Drug Programs (NCPDP) Version D.0 Claim Files  07/06/2010  6816 R1844CP  11/06/2009  Additional Health Insurance Portability and Accountability Act (HIPAA) 837 5010 Transitional Changes and Further Modifications to the Coordination of Benefits Agreement (COBA) National Crossover Process 04/05/2010  6658 R1841CP  10/29/2009  National Council for Prescription Drug Programs (NCPDP) Version D.0. Coordination of Benefits (COB) Requirements for the National C laims Crossover Process 04/05/2010  6664 R1727CP  05/01/2009  Coordination of Benefits Agreement (COBA) Repair and Claims Recovery Requirements Stemmin g from the Health 10/05/2009  6420  Rev #  Issue Date  Subject  Impl Date  CR#  Insurance Portability and Accountability Act (HIPAA) 5010 Claims Transactions R1720CP  04/24/2009  Health Insurance Portability and Accountability Act (HIPAA) American National Standards Institute (ANSI) 837 5010 Coordination of Benefits (COB) Requirements --Part II  07/06/2009  6374 R1704CP  03/20/2009  Modifications to the National Coordination of Benefits Agreement (COBA) Crossover 07/06/2009 and 10/05/2009  6343 R1640CP  11/21/2008  Modifications to the National Coordination of Benefits Agreement (COBA) Process  04/06/2009  6234 R1568CP  08/01/2008  Health Insurance Portability and Accountability Act (HIPAA) American National Standards Institute (ANSI) X12- N 837 version 5010 Changes Necessary for Coordination of Benefits (COB) and other Coordination of Benefits Agreement (COBA) Process Revisions  01/05/2009  6103 R1507CP  05/16/2008  Coordination of Benefits Agreement (COBA) and Affiliate National Provider Identifier (NPI) Process Modifications  10/06/2008  6024 R1497CP  05/02/2008  Modifications to the National Coordination of Benefits Agreement (COBA) Crossover Process  07/07/2008  6037 R1436CP  02/05/2008  Modifications to the National Coordination of Benefits Agreement (COBA) Crossover Process  Replaced by Transmittal 1497 07/07/2008  5866 R1420CP  01/25/2008  Clarification Regarding the Coordination of Benefits Agreement (COBA) Medigap Claim- Based Crossover Process  02/01/2008  5837 R1332CP  08/31/2007  Transitioning the Mandatory Medigap (Claim Based) Crossover Process to the 10/01/2007  5601  Rev #  Issue Date  Subject  Impl Date  CR#  Coordination of Benefits Contractor (COBC)  R1296CP  07/18/2007  Modifications to the National Coordination of Benefits Agreement (COBA) Crossover Process  10/01/2007  5569 R1282CP  07/06/2007  Medicare Contractors Use of the Coordination of Benefits Agreement (COBA) Problem Inquiry Request Form and Send COBA Related Issues  to the COB Contractor 08/06/2007  5656 R1242CP  05/18/2007  Transitioning the Mandatory Medigap (Claim Based) Crossover Process to the Coordination of Benefits Contractor (COBC)  10/01/2007  5601 R1232CP  04/27/2007  Modification to the Coordination of Benefits Agreement (COBA) Crossover Process - Replaced by Transmittal 1296 10/01/2007  5569 R1189CP  02/28/2007  Differentiating Mass Adjustments From Other Types of Adjustments and Claims for Crossover Purposes and Revising the Detailed Error Report Special Provider Notification Letters  Replaced by Transmittal 1189  07/02/2007  5472 R1179CP  02/02/2007  Differentiating Mass Adjustments From Other Types of Adjustments and Claims for Crossover Purposes and Revising the Detailed Error Report Special Provider Notification Letters  Replaced by Transmittal 1189  07/02/2007  5472 R1110CP  11/09/2006  Excluding Sanctioned Provider Claims from the Coordination of Benefits Agreements (COBA) Crossover Process  04/02/2007  5353  Rev #  Issue Date  Subject  Impl Date  CR#  R1038CP  08/25/2006  COBC Sending Copy of Trading Partner's Eligibility File to Medicare Contractor for Use in Recovery Process  01/02/2007  5250 R1006CP  07/21/2006  Modification to the Coordination of Benefits Agreement (COBA) Claims Selection Criteria and File Transfer Protocols  10/02/2006  5094 R967CP  05/26/2006  Modification to the Coordination of Benefits Agreement (COBA) Claims Selection Criteria and File Transfer Protocols  10/02/2006  5094 R837CP  02/03/2006  Coordination of Benefits Agreement (COBA) Full Claim File Repair Process  07/03/2006  4277 R666CP  09/02/2005  Updates to the Coordination of Benefits Contractor (COBC) Detailed Error Report File Layouts 10/03/2005  4042 R586CP  06/17/2005  Modification to the National Coordination of Benefits Agreement (COBA) File Transfer and Financial Reporting Processes 10/03/2005  3906 R474CP  02/11/2005  Detailed Error Report Notification Process to COBA Partners  07/05/2005  3709 R448CP  01/21/2005  Timeframe for Execution of Crossover Agreements and Update on the Transition to the National Coordination of Benefits Agreement (COBA ) Program  02/22/2005  3658 R250CP  07/23/2004  Update of CWF Procedures 01/03/2005  3404 R158CP  04/30/2004  Transition to Medicare Coordination of Benefits Contractor (COBC) 10/04/2004  3273 R138CP  04/09/2004  Transition to Medicare Coordination of Benefits Contractor (COBC)  07/06/2004  3218 R098CP  02/06/2004  Transition to Medicare Coordination of Benefits Contractor (COBC)  07/06/2004