Follow-up on Crossover Claims

Blue Cross Blue Shield of Louisiana:

• Wait 21 days before conducting follow-up on iLinkBLUE Blue Cross Blue Shield out-of-state plans:

• Wait 30 days before contacting the out-of-state plan Services Excluded or Not Covered by Medicare When a charge is considered excluded or not covered, providers are not required to wait the 31 days to file the claim. The claim should contain a GY modifier with the specific, appropriate, HCPCS code, if available. If there is not a specific HCPCS code, a “not otherwise classified code” (NOC) must be used with the GY modifier.

These claims can be filed electronically or on paper to Blue Cross and Blue Shield of Louisiana.

Medicare Payment Rules for Consultation Services

Medicare no longer recognizes consultation CPT codes 99241-99245 and 99251-99255. This applies for both Medicare-primary and Medicare-secondary claims. Please Note: These codes are still valid CPT codes for 2010, and Blue Cross continues to accept these

consultation codes. We have current allowable charges for these codes and any changes in allowable amounts or billing policies for these codes will be communicated to our providers with a 90-day notice. At this time, we do not anticipate any changes.

Per CMS, physicians and others must bill an appropriate Evaluation and Management code for the services previously paid using the consultation codes. If the primary payer for the service continues to recognize consultation codes, physicians and others billing for these services may either:
1. Bill the primary payer an Evaluation and Management code that is appropriate for the service, and then report the amount actually paid by the primary payer, along with the same Evaluation and Management code, to Medicare for determination of whether a payment is due; or

2. Bill the primary payer using a consultation code that is appropriate for the service, and then report the amount actually paid by the primary payer, along with an Evaluation and Management code that is appropriate for the service, to Medicare for determination of whether a payment is due.
Note: The first option may be easier from a billing and claims processing perspective.

For more on this from the CMS, go to
www.cms.hhs.gov/MLNMattersArticles/downloads/MM6740.pdf and www.cms.hhs.gov/MLNMattersArticles/downloads/SE1010.pdf.
If you have any questions or require additional information on Medicare supplemental claims, please contact Provider Services at 1-800-922-8866.

Medicare Part A Benefit Exhaust Claims Requirements

Blue Cross requires the following when Medicare Part A benefits exhaust:

• Medicare exhaust letter, including the date Medicare benefits exhausted. Medicare Part A charges and Explanation of Benefits (EOB) must match.
• Blue Cross authorization from the date Medicare benefits exhausts.
• Medicare EOB for the entire stay.
• When Medicare has exhausted for the entire stay, one (1) claim needs to be submitted with admit date to discharge date inclusive of all Part A charges.
• When Medicare exhaust in the middle of the stay, two (2) claims should be submitted with one claim representing all services from the admit to the exhaust date and another claim listing the exhaust date to discharge date.
If you have questions, please email Network.Administration@bcbsla.com.