Part D Data Sharing. Harry Gamble Office of Financial Management CMS.
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Office of Financial Management
The MMA requires unprecedented coordination between CMS, State agencies, insurers, and employers to ensure that the benefits provided to Part D beneficiaries are maximized. States have special coordination concerns because of their dual status as employers and insurers.
In 1999, CMS named Group Health, Inc. (GHI) as the Coordination of Benefits (COB) Contractor. The COB Contractor consolidated activities to support the collection, management, and reporting of all health insurance coverage of Medicare beneficiaries to implement an improved plan for coordinating Medicare benefits with other insurance coverage.
CMS is modifying its Coordination of Benefits activities to collect and share drug enrollment data. These modifications will assist States in administering their employer and insurer benefits programs.
CMS is currently consolidating the claims crossover Trading Partner Agreements with Medicare contractors into the COBA process at the COB Contractor. Agreements are negotiated and maintained between CMS and supplemental health insurers (and Medicaid State Agencies, and their fiscal agents) for the exchange of entitlement and paid claims data.
This process will coordinate correct claim payments by Medicare and supplemental health insurers. It is being expanded to report other drug coverage that is supplemental to Part D to facilitate the tracking of TrOOP and to facilitate billing at the pharmacy.
CMS is developing a process similar to the VDSA program for SPAPs to receive Medicare Part D entitlement information.