Fundamentals of Medicare

Section 2: Medicare Basics


Coordination of Benefits Trading Partners

COBC exclusively crosses over all claims to trading partners. “Trading partner” is defined as an issuer of an insurance policy that supplements Medicare or a state agency responsible for administration of Title XIX of the Social Security Act.

It is also defined as a federal agency, or contractor thereof, that administers and provides health care benefits for its eligible beneficiaries or an entity working under contract with a self-insured employer plan or an insurer to adjudicate claims and perform other insurance functions.

A trading partner does not include entities that merely receive, route, and/or translate files, such as health care clearinghouses, network service vendors, data transmission services, and billing services. CMS and its COBC may, however, transmit crossover claims to trading partners through one of these entities.

For additional information visit Coordination of Benefits Agreement on the CMS website.

Reviewed 6/4/2024