What are medicare crossover claims
Medicare Crossover Claims Submission Reminder
May 29, 2014
Blue Cross and Blue Shield Plans have been using the Centers for Medicare and Medicaid Services (CMS) crossover process to receive Medicare primary claims since January 2006. The CMS crossover process routes Medicare Supplemental claims (Medigap and Medicare Supplemental) directly from Medicare to Blue Cross and Blue Shield of Texas (BCBSTX) so that providers do not need to also submit the claim to BCBSTX. Over the years, this Medicare crossover process has helped increase efficiency by requiring one claim submission, reducing duplicate submissions, improving payment accuracy, and increasing member and provider satisfaction.
Although the above process is clear, providers have continued to submit the claim to both Medicare and BCBSTX resulting in duplicate claims. These duplicate claims result in additional, unnecessary work and possible inaccurate claims processing, which in turn has a negative impact on providers, members and Plans.
When the Home Plan receives a Medicare Primary claim before it is crossed over, it may be incorrectly paid based on an estimated Explanation of Medicare Benefits (EOMB). Provider payment should be calculated based on the actual EOMB. Members are also impacted when providers submit duplicate claims. When the Home Plan uses an estimated EOMB, they may incorrectly calculate member cost sharing.
In an effort to improve the Medicare crossover administrative process, all providers are instructed to follow new rules concerning Medicare secondary claim submission. When a claim has been crossed over, providers are to wait 30 calendar days from the initial Medicare remittance date before submitting the claim to BCBSTX.
As a reminder, effective Oct. 13, 2013, claims received on or after that date could potentially be impacted.BCBSTX will reject provider submitted claims when Medicare is considered primary including those with Medicare exhausted-benefits that have crossed over if they are received within 30 calendar days of the initial remittance date or with no Medicare remittance date. It is expected that this modification will address duplicate claim submissions.
How do I submit a claim when Medicare is primary and Blue Plan is secondary?
- Submit claims to your Medicare carrier when Medicare is considered primary and the Blue Plan is secondary.
- When submitting the claim, it is essential that you enter the correct Blue Plan name as the secondary carrier. This may be different from the local Blue Plan. Check the member’s ID card for additional verification.
- Be sure to include the alpha prefix as part of the member number. This alpha prefix is located on the members ID card as
the first three characters. The alpha prefix is critical for confirming membership and coverage, and if not provided, may delay payments.
When you receive the remittance advice from Medicare, determine if the claim has been automatically forwarded (crossed over) to the Blue Plan:
- Remark codes MA18 or N89 on the Medicare remittance will indicate that the claim was crossed over. The claim has been sent on your behalf to the appropriate Blue Plan for processing. You do not need to resubmit that claim to BCBSTX.
- If the remittance indicates that the claim was not crossed over, submit the claim to BCBSTX with the Medicare remittance advice.
- In some cases, the member ID card may include a Coordination of Benefits Agreement ID number. If so, be certain to include that number on your claim.
If you have any questions or need to request the status of a claim, inquiries should be submitted in the following manner:
- Electronically – send a HIPAA transaction 276 (claim status inquiry) to BCBSTX through your preferred online vendor portal.
- By phone – call our Interactive Voice Response (IVR) automated phone system at 800-451-0287 ,
When should I expect to receive payment?
The claims you submit to the Medicare carrier will be crossed over to the Blue Plan only after they have been processed by the Medicare intermediary. This process may take approximately 14 business days to occur. This means that Medicare will be releasing the claim to the Blue Plan for processing about the same time you receive the Medicare remittance advice. As a result, upon receipt of the remittance advice from Medicare, it may take up to 30 additional business days for you to receive payment or instructions from the Blue Plan.
What should I do in the meantime?
If you submitted the claim to the Medicare carrier, and haven’t received a response to your initial claim submission, do not automatically submit another claim. Rather, you should:
- Review the automated resubmission cycle on your claim system.
- Wait 30 calendar days from receipt of the Medicare Remittance advice.
- To avoid submitting a duplicate claim, check the status of the initial claim before resubmitting.
If you use a billing service or clearinghouse to submit claims on your behalf, please be sure they are aware of this information. For more information about submitting claims or checking the status of a claim, visit the Claims and Eligibility section.Source: www.bcbstx.com