HealthCare News

Medicare Crossover for Mass Adjustments

Issue: #398 DEC2017

Topic: Coding/Billing

All Blue Cross Blue Shield (BCBS) Plans have been processing Medicare crossover claims for services covered under Medigap and Medicare Supplemental products through Centers for Medicare & Medicaid Services (CMS). This has resulted in automatic submission of Medicare claims to the BCBS 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 has also allowed Medicare crossover claims to be processed in the same manner nationwide.

The Blue Cross and Blue Shield Association (BCBSA) recommends the following action:

BCBS Plans do not allow crossover claims for mass adjustment. Blue Cross Blue Shield of North Dakota (BCBSND) will not receive Medicare crossovers related to these mass adjustments. However, providers may initiate claim adjustments if they choose.

Note: The Federal Employee Program (FEP) has also adopted the process recommended by the BCBSA.

The Medicare remittance advice will indicate if the claim has been automatically forwarded (crossed over) to the BCBS Plan:

  • If the remittance indicates that the claim was crossed over, Medicare has forwarded the claim on your behalf to the appropriate BCBS Plan and the claim is in process. There is no need to resubmit that claim to BCBSND.
  • If the remittance indicates that the claim was not crossed over and you feel it is necessary for the claim to be adjusted, you may choose to submit a claim adjustment form to BCBSND with the Medicare remittance advice.