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PAP402

Medicare Crossover Claims


Provider Administrative Policy

Section
Hospital
Policy Date
February 2008
Status/Date
Revised/October 2009
Provider Type(s)
Hospitals  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts


Policy

Medicare Crossover Claims

When Medicare is the primary payer and Blue Cross of Idaho is the secondary payer, Medicare electronically submits the remainder of any Medicare claim to Blue Cross for reimbursement. The crossover process includes both Medigap and Coordination of Benefits (COB) claims.

We send a monthly electronic file of enrollees to Medicare when Blue Cross of Idaho provides secondary coverage. Because our file may not have complete Medicare enrollee information, please check your Medicare remittance to determine if a crossover occurred.

If a crossover has not occurred within 30 days, contact the Blue Cross of Idaho Customer Service Department and provide us with the Medicare membership number. A representative will verify if a Medicare notation is on file for your patient. If not, they will ask you to submit your claim with the Medicare payment information for processing with the member's Medicare information such as subscriber number, effective date and coverage. We can then update our files so future claims will crossover from Medicare.

Please do not send a duplicate hard copy or electronic claim to us for processing when it appears to have crossed over.

Beginning October 13, 2013, Blue Cross of Idaho will reject Medicare primary BlueCard claims submitted for services covered by Medicare, when filed to Blue Cross of Idaho within 30 days of Medicare's process date.

You may submit claims to Blue Cross of Idaho for services or items statutorily non-covered or not a  Medicare-covered benefit, when Medicare is primary, using the appropriate modifier (refer to PAP248). Claims will not require the 30 day waiting period.

See PAP100 for customer service phone numbers and hours of operation.


Policy History

Date Action Reason
September 2013 Revised Added BlueCard claims filing waiting period
October 2009 Revised Title change/Medicare information added

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