(the plus sign) beside a panel to open the panel. Click 
(the minus sign) to close the panel. You use the Provider Inquiry/Maintenance - Medicare page when you view or edit a provider’s Coordination of Benefits Agreement (COBA) - also known as Medicare Crossover. This information includes previously assigned Medicare numbers, previously used Medicare carriers, and the programs in which the provider participated. This information may be needed to process historical Medicare claims sent to ND MMIS for secondary payment processing.
The Provider Inquiry/Maintenance - Medicare page contains the following pod and panel:
You can open or close certain panels. Click (the plus sign) beside a panel to open the panel. Click (the minus sign) to close the panel.
If you access this page through Provider Inquiry, all fields are view-only.
| Fields | Description |
|---|---|
| ID | The provider's ND Medicaid number. |
| Name | The provider's name. |
| Type |
The type of provider enrolling. Examples: Group, Individual |
| Status |
The provider's status Examples: Active, Inactive |
| P-SYS-ID | The provider's internal system identification number. This is a system generated, unique, sequential number. |
| To go to a specific page, in the Details or Maintenance pod, click the link. | |
| Field Name | Description |
|---|---|
| To add Coordination of Benefits Agreement (COBA) information, click Add COBA Data. To view or edit, in the COBA table, click the appropriate row. | |
| Medicare # | The provider's Medicare number. |
| Medicare Program | Indicates in which Medicare program the provider participates. |
| Begin Date | The date the provider's Medicare begins. |
| End Date | The date the provider's Medicare ends. |
| Carrier Name or Carrier ID - Name | ID and name of the Medicare intermediary carrier, if applicable. |
Version as of 5/16/14.
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