CMS Pub. 100-04, ch. 27, § 80.10

Coordination of Benefits Agreement (COBA) Crossover Purposes

(Rev. 4474, Issued; 12-06-19, Effective: 01-04-20, Implementation: 01-06-20)

Effective April 6, 2020, CWF shall begin to support the inclusion and exclusion of Part B

psychotherapy claims via the COBA crossover process.

Inclusion of Part B Psychotherapy Claims

When CWF determines through reading the modified COBA Insurance File (COIF) that

a COBA trading partner wants to receive Part B psychotherapy claims only, it shall

select the claim for crossover purposes under the following circumstances:

• The claim’s Part B psychotherapy provider specialty code (i.e., code 26, 62, 68,

80, or 89), as received via the Health Utilization Part B claim (HUBC)

transaction, matches the COIF specifications for inclusion of Part B

psychotherapy claims; and

• The claim does not otherwise meet other exclusion logic specified on the COIF;

and

• As applicable, the corresponding original claim was not previously excluded from

crossing over. (Note: This relates to the CWF crossover disposition code “R”

logic and applies to adjustment claims. See Section 80.5 for more information

regarding crossover disposition code R.)

Exclusion of Part B Psychotherapy Claims

In determining whether a base COBA trading partner (i.e., an insurer or other health

benefit organization that carves out the processing and payment of mental health claims

to another organization) wishes to exclude Part B psychotherapy claims through the

COBA process, CWF shall:

• Verify if the claim's Part B psychotherapy provider specialty code matches the

COBA trading partner's exclusion criteria per the COIF; and

• Exclude the claim if a match is found.

Important: The CWF maintainer shall permit the inclusion or exclusion of some or all

Part B psychotherapy provider specialty codes in accordance with the information

specified on the COIF.

Crossover Disposition Indicators

CWF shall create a new COBA crossover disposition indicator “AG” (see Section 80.5

for further details regarding this crossover disposition indicator) that it will apply when

the HUBC claim does not meet the provider specialty code inclusion criteria.

In addition, CWF shall create a new COBA crossover disposition indicator “AH” (see

Section 80.5) that it will apply when the base COBA trading partner specifies it wishes to

exclude Part B psychotherapy claims from crossing over.

As applicable, CWF shall display the new “AG” and “AH” crossover disposition

indicators on page 2 of the PTBL claims detail screen on HIMR.