Claim File Submission Error Report (CFSER)- Failed Coordination of Benefits Agreement (COBA) Claims, CR 24865

December 10, 2013

The MIHMS Health PAS Online Portal will now include a CFSER, similar to the Business Rejection Report, for the loading of COBA claims. This error report will detail any COBA claims that fail to load in MIHMS. You can access the CFSER by logging into your trading partner account and clicking on the “ED10009” links under File Exchange> Reports> Other Reports. The reports are listed by date. Click on the hyperlinked dates to view your reports. We are continuing our work to ensure that a high percentage of claims that process through Medicare are appropriately identified for COBA. If you are not registered as a Trading Partner with MIHMS, these reports will be mailed to you.

CFSCR failures will most often occur because Edifecs rules that are not necessary for MIHMS processing may cause claims to reject. We are reviewing the rules to determine if more of the rules need to be relaxed to decrease the percentage of failed COBA claims.

There are other situations when eligibility information is not sent through to COBA. While doing analysis on COBA claims, we found an issue where not all members with QMB eligibility have been submitted to COBA (CR32780). This has resulted in claims not crossing over. This type of issue would not appear CFSCR (ED10009).

In both situations, claims must be submitted to MaineCare by the provider. It is important to review your Medicare Remittance Advice which identifies the claims that crossover from Medicare. Claims that have crossed over will be reflected by a number 19 or 22 as the indicator on the Medicare Remittance Advice. If there is no crossover indicator, you should submit these claims directly to MaineCare.

Questions regarding these reports can be directed to the EDI Helpdesk at 1-866-690-5585, option #3.