Understanding the Medicare Crossover Process
The Centers for Medicare & Medicaid Services (CMS) has established a crossover system that automatically forwards Medicare Part B claims to secondary insurers, such as Blue Cross Blue Shield (BCBS), when a beneficiary has a Medigap policy. This process eliminates the need for healthcare providers to submit separate claims to BCBS for supplemental coverage.
When a claim is processed by Medicare, it is automatically sent to the appropriate BCBS plan for secondary payment. Providers should not submit duplicate claims to BCBS, as this can lead to processing delays and potential payment issues.
For more information on the crossover process, refer to the BCBSTX Medicare Crossover Claim Submissions page.
When Manual Submission is Necessary
While the crossover process is designed to be automatic, there are instances where a claim may not be forwarded to BCBS. In such cases, providers are responsible for submitting the claim manually. Situations requiring manual submission include:
- The Medicare remittance advice does not indicate that the claim was crossed over.
- The patient’s information was incomplete or incorrect, preventing automatic crossover.
- The provider is out-of-network or the service is not covered under the crossover agreement.
Providers should monitor remittance advices for indicators such as remark codes MA18 or N89, which signify that the claim was automatically forwarded. If these codes are absent, manual submission is necessary.
Detailed instructions for manual submission can be found in the Blue Shield of California Medicare Crossover Education document.
Steps for Manual Claim Submission to BCBS
If manual submission is required, follow these steps to ensure proper processing:
- Obtain the Explanation of Medicare Benefits (EOMB) from the primary Medicare claim.
- Prepare a claim using the HIPAA-compliant 837 format or complete the appropriate paper claim form.
- Include all necessary documentation, such as the EOMB and any other required attachments.
- Submit the claim electronically through your clearinghouse or directly to the BCBS plan, or mail it to the designated BCBS address.
For specific mailing addresses and electronic submission details, consult the BCBSIL Med B Supplemental Claims Submission Guide.
Best Practices for Providers
To streamline the claims process and reduce the likelihood of errors:
- Verify patient information and ensure that the BCBS plan details are accurately recorded.
- Monitor remittance advices for crossover indicators and take prompt action if a claim was not forwarded.
- Avoid submitting duplicate claims to both Medicare and BCBS to prevent processing delays.
- Stay informed about updates to the crossover process and BCBS submission guidelines.
For additional resources and support, visit the BCBSM Medicare Claims Submission page.
Disclaimer: This article is for informational purposes only and does not constitute legal or financial advice. Providers should consult with their respective BCBS plans for specific submission requirements.