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Helpful Hints Before Digging Deeper into COB
Medicare and Veterans Affairs
(VA)
For ESRD injury claims, Medicare will never be
primary over:
Medicare and VA are both federally-
funded programs, therefore DaVita
should not have both programs
together in a patient’s coverage
string. In other words, we should
never have Medicare and VA set for
the same claim in primary,
secondary or tertiary positions.
If ESRD was caused by a service
related injury, VA is responsible for
the care of the patient. If VA
cannot provide the service due to
not having a facility or hospital in a
nearby area, they may provide an
authorization for the care to be
outsourced.
Worker’s Compensation plans
Liability policies
No-fault insurance claims (Such as auto
liability)
Medicare will always be
primary over:
Medicaid / Managed Medicaid
Medigap Plans
True supplement plans that
would not pay if the patient
didn’t have Medicare
State Renal Plans
Indian Health Services (IHS)
TRICARE for Life
CHAMPVA
Individual commercial policies
Example: Self–employed
patient purchases Cigna
plan for their family. Since
they are self-employed,
there is no “employer
group”
** Remember, the patient must be covered under an EGHP for a 30-month
COB period to be possible. **