US · guidance
CMS Pub. 100-11, ch. 14, § 10
Introduction
In 1980, Congress enacted the first of a series of provisions that made Medicare the
secondary payer to certain additional primary plans. These provisions are known as the
Medicare Secondary Payer (MSP) provisions and are found at Section 1862(b) of the
Social Security Act. These provisions prohibit Medicare from making payment if
payment has been made or can reasonably be expected to be made by the following
primary plans when certain conditions are satisfied: group health plans, workers’
compensation plans, liability insurance, or no-fault insurance (The private insurance
industry generally talks about "Coordination of Benefits" when assigning responsibility
for first and second payment).
The purpose of the Coordination of Benefits (COB) process is to identify the health
benefits available to a Medicare beneficiary and to coordinate the payment process to
prevent mistaken payment of Medicare benefits.
History
(Rev. 2, Issued: 06-09-11; Effective: 06-03-11; Implementation: 06-03-11)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
81b3e8261c49bb5d274bccb35be3f62fb7a3130b860c40f5080801beb848751e
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