Benefits Coordination & Recovery Center (BCRC), GHP

Crossover Claims

CMS implemented the Coordination of Benefits Agreement (COBA), which states that the Coordination of Benefits Contractor (COBC) will process all claims crossovers. Government Health Incorporated (GHI) is the contractor selected by CMS.

The BCRC consolidates the activities that support the collection, management, and reporting of other insurance coverage for Medicare beneficiaries. The purposes of the Coordination of Benefits (COB) program are to identify the health benefits available to a Medicare beneficiary and to coordinate the payment process to prevent mistaken payment of Medicare benefits. The BCRC does not process claims, nor does it handle any mistaken payment recoveries or claims specific inquiries. The Medicare intermediaries are responsible for processing claims submitted for primary or secondary payment.

Claim Crossover Process
An eligibility file is sent from the Trading Partner (supplemental insurance company) to the BCRC. The file contains data to identify the Medicare ID and claims criteria, specified by the Trading Partner, for crossovers. Each Trading Partner is issued a COBA ID. The COBA ID and eligibility file data, along with information specific to that trading partner, are stored in Medicare's Common Working File (CWF). When claims are processed, CWF compares each COB trading partner's claims selection criteria against the Medicare claims. If the claim matches the Trading Partner's claims criteria and Medicare ID in their eligibility file, the claim information is automatically forwarded to the Trading Partner, via an electronic file.

Trading Partner's File Must Contain Medicare ID
Caims with the Medicare ID not on the Trading Partner's eligibility file will not be crossed over. The claim information must match the claim criteria specified by the Trading Partner in the eligibility file.

Verification that Claim Crossover Occurred
The payment section, on page six of the Direct Data Entry (DDE) system, contains a "CROSSOVER IND" field. This field will either be blank or have a value of 1 in it. If it is blank, the claim did not cross over. If it contains a "1", the claim did cross over to the Trading Partner in the field titled "PARTNER ID." The Trading Partner ID is a nine-digit ID assigned by BCRC. The payment data section in DDE (claim pg. 06) will indicate the same fields as mentioned above, "CROSSOVER IND" and "PARTNER ID". The crossover information can also be found on the ANSI 835 Electronic Remittance Advice in the "TRANSFER TO (COB)" field. The Trading Partner's ID will be located in the "ID CODE" field on the ERA. If the claim crossed over to multiple Trading Partners, only the first one will be listed on the ERA.

Multiple Secondary Insurance Companies Receiving Crossed Over Claims
The claims will be crossed over simultaneously, but who gets paid first is predetermined by the secondary/tertiary payers from the eligibility files in the national eligibility system HIMR, also known as the CWF.

Crossover Claims Not Received By Secondary Insurance Companies
Because Medicare no longer crosses claims over, providers must contact the Trading Partner so they may investigate the situation to confirm if it is an internal issue or an issue with the BCRC. Within the "Downloads" section of the CMS Coordination of Benefits Agreement webpage, locate Trading Partner ID information and find the most current listing of the "COBA Trading Partners Customer Service Contacts" (List of Automatic Crossover Trading Partner (Insurers) In Production).

There may be times Medicare records indicate claims crossed over but Trading Partner says they did not receive them
This situation could suggest that some type of error occurred during the crossover process from the Medicare contractor to the BCRC, or from the BCRC to the trading partner. In order to determine if such an error occurred or if a problem exists, the trading partner must contact the BCRC. The BCRC will correct any possible issues on their end, or report to Noridian any issues that require action on the part of Noridain. Noridian can verify whether Medicare claims processing records indicate crossover; however, when our records indicate that claims did not crossover, we cannot provide any specifics on the trading partner's criteria.

If supplemental insurer information was not on the claim, it can still crossover. The CWF includes the eligibility file that contains specific information pertaining to the trading partner contracted with the BCRC. As Medicare claims are processed, CWF applies each COB Trading Partner's claims selection criteria against the Medicare claim. The COBA ID of the Trading Partner and their eligibility file data are stored in CWF. The eligibility file is sent from the Trading Partner to the BCRC. The file contains data to identify the claims for crossover.

The COBC Detailed Error Report, listing the claims that did not cross over to the trading partners, will be issued to the provider. This report would notify a provider of any situation that may prevent Medicare from crossing over a claim that is on the eligibility file. The provider on the report will need to take appropriate action to obtain payment from the supplemental payer.

Contact

Contact BCRC

BCRC Customer Service Representatives are available to assist you M-F 8 a.m. - 8 p.m. ET, except holidays, at toll-free lines: 1-855-798-2627 (TTY/TDD: 1-855-797-2627 for the hearing and speech impaired).

BCRC Address

BCRC - GHP
P.O. Box 138897
Oklahoma City, OK 73113-8897

Contact BCRC to:

  • Report employment changes, or any other insurance coverage information
  • Report a liability, auto/no-fault, or workers compensation case
  • Verify Medicare's primary/secondary status. Note: Insurer information will not be released. Provider/supplier must request information on payers primary to Medicare from beneficiary prior to billing. Since BCRC must protect rights and information of beneficiaries, they cannot disclose this information
  • Ask general Medicare Secondary Payer (MSP) questions/ concerns
  • Ask questions regarding MSP Development letters and questionnaires
  • Report changes to a beneficiary's health coverage
  • Report a beneficiary's accident/injury

BCRC cannot assist with:

  • Information concerning how to bill for payment (e.g., value codes, occurrence codes) - Contact Noridian
  • Inquiries related to specific claims or recoveries - Contact Noridian
  • Information regarding beneficiary entitlement data. Current regulations do not allow BCRC to provide entitlement data to provider
  • Insurer information. The BCRC is permitted to state whether Medicare is primary or secondary but cannot provide name of other insurer. Provider must obtain this information from beneficiary since Privacy Act prohibits release of this information

Contact Noridian to:

  • Answer questions regarding Medicare claim or service denials and adjustments
  • Answer questions about how to bill for payment
  • Process claims for primary or secondary payment
  • Accept return of inappropriate Medicare payment

 

Last Updated Jul 16, 2019