Section title: Requests for Interpretation
RFI #
2403
271 COB Payer Name
Description

We have a vendor that currently reports Medicare COB information in the 271 response as follows:
EB*R~
DTP*290*RD8*20070601-99991231~
LS*2120~
NM1*PR*2*MEDICARE A~
LE*2120~
EB*R~
DTP*290*RD8*20070601-99991231~
LS*2120~
NM1*PR*2*MEDICARE B~
LE*2120~
We believe this does not follow 270/271 TR3 requirements for reporting COB/Other payer information as it conveys coverage information for Medicare. Loop 2120C/D NM103 should reflect the COB payer name not “Medicare A” or “Medicare B”. If X12 agrees this does not follow TR3 requirements, we would also appreciate confirmation if ‘Medicare’ would be considered an appropriate other payer name in this situation or if the MAC name or ‘Centers for Medicare and Medicaid Services’ would be more appropriate.

Response

Medicare Part A (Hospital) and Medicare Part B (Professional) are insurance types (see 2110C EB04) that would be returned by Medicare or the contracted MAC. While insurance type codes may be considered “coverage details,” it may be beneficial for the receiver of the 271 to understand what insurance type the information source is deemed a COB payer. While including “Part A” and “Part B” is not a preferred approach, it’s an acceptable way to convey that the other payer is providing COB to either Part A or B, or both. 
 
Another approach to take would be to return Centers for Medicare and Medicaid Services (or the contract MAC name) in NM103, and return the Part A and/or Part B contact in 2120C PER02 as the contact information may be different for Part A and B.
 
Additionally, 2120C NM103 should include the payer or entity that would be sent the follow-up 270, either CMS or a MAC. It’s likely that the information source who received the 270 and has COB coverage for the member knows whether the additional coverage is for Part A or B.

RFI Recommendation

The 2110C DTP dates in submitter’s example of Medicare Part A and B coverages should not be returned as those dates may also be considered “coverage” details. The “other payer” would supply the dates that correspond to them upon receipt and processing of that follow-up 270 to that other payer. While Part A and Part B may be considered coverage details, they are a necessary reference to distinguish what contact information goes with what COB payer.

DOCUMENT ID
005010X279