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PAP802

Medicare Supplemental Claim Submission/Requirement


Provider Administrative Policy

Section
BlueCard
Policy Date
April 2007
Status/Date
Revised/September 2014
Provider Type(s)
All Providers  

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 Supplemental Claim Submission/Requirement

Send all Medicare supplement claims to your local contracting Blue Cross Blue Shield Plan. Use the following guidelines when submitting your Medicare supplement claims:

  • File with the Medicare contractor first. Include complete health insurance claim number (HICN), patient’s complete identification (ID) number, including alpha prefix, and Blue Cross Blue Shield plan name as it appears on the member’s ID card in the other insurance field.
  • Do not file with Blue Cross of Idaho and Medicare simultaneously.
  • Determine if the claim automatically crossed over to supplemental insurer. If it crossed over, do not resubmit your claim.
    • Use BlueExchange when a provider request a claim remittance advice for Medicare crossover claims.
  • Wait until you receive the Explanation of Medicare Benefits (EOMB) or payment advice from Medicare.  Once it is determined the claims did not successfully crossover to the member`s home plan, submit your claim(s) to your local contracting Blue Cross Blue Shield Plan.
    • Beginning October 13, 2013, Blue Cross of Idaho will reject Medicare primary BlueCard claims submitted for services covered by Medicare.
    • 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).
  • Reimbursement for Medicare supplements will follow Medicare assignment regardless of contracting status with Blue Cross of Idaho.
  • You will receive payment directly if accepting assignment on the Medicare claims.
  • If you do not accept assignment on the Medicare claim, the patient could receive direct payment.

When you provide services to BlueCard members and Medicare is the primary payor and a Blue Cross Blue Shield Plan (outside of Idaho) is the secondary payor, Medicare will crossover the claim(s) to the member’s Blue Cross Blue Shield home plan. The member may receive payment depending on the practices of the home plan payor.

If you do not receive payment from the secondary payor within 30-45 days from the Medicare payment date and the remittance indicates the claim crossed over, please contact the member for payment (see PAP201 and PAP402).

This policy does not apply to the Department of Veterans Affairs (VA).

You may also contact the Provider Call Center (see PAP100).


Policy History

Date Action Reason
September 2014 Revised Addin Medicare language from PAP402
October 2013 Revised Updated to reflect policy does not apply to the VA
January 2010 Revised Language clarification on crossovers

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