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Back  RFI # 1556: Medicare B Crossover 5010 835

Formal vs. Informal Help Informal Formal


Charlie Oltman


Pharmacies are seeing issues with the Medicare B COBA payments, Where the Medigap plan is sending the check to the individual store versus the corporate address in the Pay To Loop of the 837P. This is a major change to the 5010 837P, and it appears many of the health plans did not code to it. Refer to a December 2011 letter of clarification from the Medicare B EDI department. Can this be brought to the attention to X12 members?

From: COBVA [mailto:COBVA@ghimedicare.com]
Sent: Wednesday, December 28, 2011 10:02 AM
Subject: COBVA Alert--Reminder Concerning Reporting of Pay-To Information on Version 5010 Coordination of Benefits (COB)/Crossover Claims

Submitter Assigned Keywords

Medicare B Crossover 5010 835


As designated by the 5010 implementation guide, the N3 and N4 address in the Pay-To Address 2010AB loop is the requested address for payment, when that address is different than the address reported in the Billing Provider 2010AA loop N3 and N4. In the case of a payer to payer COB claim, the 2010 Pay-To Address may be the Pay-To Address for remittance and check payment purposes from the previous payer's provider file.
Submission 4/2/2012
Status Date 6/29/2012
Status F - Final
Primary References
Document 005010X222
Segment PositionN3,N4
Segment IDN3
Industry NamePay-to Provider Loop