MEDICARE SECONDARY PAYER SCREENING FORM As a direct 2025

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In most cases, Medicare automatically crosses over patients claims to supplemental insurers, provided those insurers participate in the COBA crossover process. To learn about the Medicaid Crossover process, select the Medicaid Crossover button.
Paper claim submission The paper claim MUST include a copy of the primary insurers explanation of benefits (EOB). The EOB should include the following information: Name and address of the primary insurer. Name of subscriber and policy number.
Call the Benefits Coordination Recovery Center at 1-855-798-2627. TTY users can call 1-855-797-2627. Contact your employer or union benefits administrator. Also, tell your doctor and other health care providers about your health or drug coverage changes the next time you get care.
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