decisionhealth Newsletters, Answer Books - 2006 Issue 3 (March)
Program_Memos / 2001 / AB-01-25
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Article Overview
This article explains operational guidance for Medicare intermediaries, carriers, and the COB Contractor under the coordination of benefits and Medicare secondary payer framework. It addresses how different types of inquiries and case activities are routed, how related files and correspondence are handled, and what systems and contacts are used for processing and follow-up. The memorandum is intended for contractor and claims operations staff who need to understand the updated workflow and implementation timing.
Why This Topic Matters
It helps Medicare claims and contractor personnel determine the correct handling path for MSP- and COB-related work, reducing misrouted inquiries and supporting consistent use of contractor systems and procedures.
Article Sections
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Change Request 1558
Introduces the clarification request and summarizes the scope of the memorandum. It frames the operational topics covered in the rest of the document.
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COB Contractor
Describes the contractor’s role in the revised coordination of benefits workflow. It explains the shift in responsibilities associated with the phase III implementation.
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Updating Responsibilities on the Common Working File (CWF)
Outlines how intermediary, carrier, and COB Contractor responsibilities are divided for maintaining records on the Common Working File. It also includes illustrative scenarios showing different types of inquiry handling.
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No-Fault, Workers’ Compensation, and Liability Referrals to the COB Contractor
Covers routing and handling of inquiries and cases involving no-fault, workers’ compensation, and liability matters. It distinguishes which situations remain with local contractors and which are transferred for contractor processing.
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Intermediary and Carrier Claim Referrals to the COB Contractor
Addresses claim-related referrals and clarifies that claim processing remains with the local intermediary or carrier. It also discusses related claim clarification and information transfer procedures.
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Intermediary/Carrier “I” Auxiliary Records
Summarizes guidance on when intermediary or carrier auxiliary records may be used. It notes restrictions on use when there is no pending claim or unsolicited refund.
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COB Contractor MSP Development
Describes development activities performed by the COB Contractor, including handling of trauma-related and no-fault-related information. It also explains the contractor’s role in updating records and forwarding information as needed.
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Paper Documentation
Provides mailing guidance for paper documents associated with contractor development and correspondence. It identifies which materials should be sent, returned, or routed through electronic processes.
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Electronic Correspondence Referral System (ECRS)
Explains system availability, support contacts, and follow-up expectations for ECRS-related processing. It also includes notes on request status monitoring and version availability.
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COB Consortia Representatives
Lists the circumstances under which consortia representatives may be contacted and identifies the representative groups. It supports operational escalation for specific COB and ECRS issues.
What You Will Learn
- How this Medicare memorandum updates contractor responsibilities for MSP and COB-related workflows
- How different categories of inquiries and case activities are routed between local contractors and the COB Contractor
- How the memorandum addresses record updates, electronic referrals, paper documentation, and system support
- What implementation and effective-date information is provided for the operational guidance
Who Should Read This
- Medicare intermediaries
- Medicare carriers
- COB Contractor staff
- MSP coordinators
- Claims operations personnel
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