HealthCare News

Duplicate Claims Handling for Medicare Crossover

Issue: #399 JAN2018

Topic: Coding/Billing


All Blue Plans are required to process Medicare crossover claims for services covered under Medigap and Medicare Supplement products through the Centers for Medicare & Medicaid Services (CMS). This results in automatic submission of Medicare claims to the Blue secondary payer to eliminate the need for the provider’s office or billing service to submit an additional claim to the secondary carrier. Additionally, this also allows Medicare crossover claims to be processed in the same manner nationwide.

When a Medicare claim has crossed over, providers are required to wait 30 calendar days from the Medicare remittance date before submitting the claim to Blue Cross Blue Shield of North Dakota (BCBSND).

Claims submitted to the Medicare intermediary 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, which means the Medicare intermediary will be releasing the claim to the Blue Plan for processing around the same time you receive the Medicare remittance advice. Upon receipt of the remittance advice from Medicare, it may take up to 30 additional calendar days for you to receive payment or instructions from the Blue Plan.

Providers should continue to submit claims for Medicare covered services directly to Medicare, even if Medicare may be exhausted or has been exhausted, to allow the crossover process to occur and for the member’s benefit policy to be applied.

Medicare primary claims, including those with Medicare exhausted services that have crossed over and are received by BCBSND within 30 calendar days of the Medicare remittance date or with no Medicare remittance date will be returned.

Frequently asked questions

How do I submit Medicare primary/Blue Plan secondary claims?

  • For members with Medicare primary coverage and Blue Plan secondary coverage, submit claims to your Medicare intermediary and/or Medicare carrier.
  • When submitting the claim, make sure 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.
  • Make sure you include the prefix as part of the member identification number. The member’s ID will include the prefix in the first three positions. The prefix is critical for confirming membership and coverage, and key to facilitating prompt payments.

 

When you receive the remittance advice from the Medicare intermediary, look to see if the claim has been automatically forwarded (crossed over) to the Blue Plan.

  • If the remittance indicates that the claim was crossed over, Medicare has forwarded the claim on your behalf to the appropriate Blue Plan and the claim is in process. There is no need to resubmit that claim to BCBSND.
  • If the remittance indicates the claim was not crossed over, submit the claim to BCBSND with the Medicare remittance advice.
  • If the member identification card contains a Consolidated Omnibus Budget Reconciliation Act (COBRA) ID number, make sure you include that number on your claim.
  • For claim status inquiries, contact BCBSND’s Provider Service at 1-800-368-2312 or 701-282-1090.

 

When should I expect to receive payment?

The claims you submit to the Medicare intermediary will cross 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, which means the Medicare intermediary will be releasing the claim to the Blue Plan for processing about the same time you receive the Medicare remittance advice. 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 intermediary/carrier and you 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.
  • Check claims status before resubmitting.

Sending another claim or having your billing agency resubmit claims automatically actually slows down the claim payment process and creates confusion for the member.