Monday, 10 October 2016

Medicare Supplemental Claims

In order to reduce the administrative expense and time involved with manual claims submission, in most cases, Medicare supplemental claims will automatically cross over to Blue Cross and you do not need to file a claim for the Blue Cross portion to be processed.

For out-of-state BCBS members

Blue Plans may receive crossover claims for providers who are not within their state boundaries. All claims for out-of-state Blue Plan members will be processed by the out-of-state Blue Plan listed on the member’s ID card.

Provider information at Medicare and Blue Cross of Louisiana

To further ensure eligible Medicare Supplemental claims cross over from Medicare to Blue Cross successfully, please notify us immediately of the following:

• If you have a new Tax ID number, or
• If you have not previously given Blue Cross your NPI, you must do before filing claims including your NPI. For instructions, see the National Provider Identifier section of this manual.

How to determine if the claim was crossed over from Medicare

If a claim is crossed over, you will receive a message beneath the patient’s claim information on the Payment Register/Remittance Advice that indicates the claim was forwarded to the carrier.

Example 1: “Claim information forwarded to: BCBS of Louisiana-Supplemental
Example 2: “Claim information forwarded to: BCBS of Alabama

When a Medicare claim has crossed over, providers are to wait 30 calendar days from the Medicare remittance date before submitting a claim to Blue Cross and Blue Shield of Louisiana. Claims you submit to the Medicare intermediary will be crossed over to Blue Cross only after they have been processed by Medicare. This process may take approximately 14 business days to occur. As a result, upon receipt of the remittance advice from Medicare, it may take up to 30 additional calendar days from the crossover for you to recieive payment or instructions from Blue Cross.

If the remittance does not contain a message similar to the above, the claim was not crossed over to the payer. This claim must be filed on paper to the Plan listed on the member’s ID card. The following claims are excluded from the crossover process for Blue Cross:

• Original Medicare claims paid at 100 percent
• 100 percent denied claims with no additional beneficiary liability
• Adjustment claims that are non-monetary/statistical
• Medicare Secondary Payer (MSP); claims for which other insurance exists for beneficiary
• National Council for Prescription Drug Programs (NCPDP) claims

What to do when the claim WAS NOT crossed over from Medicare  For Louisiana claims that did not crossover automatically (except for Statutory Exclusions), the provider should wait 31 days from the date shown on the Medicare remittance to resubmit the claim. Claims submitted before 31 days will be rejected on the Blue Cross and Blue Shield of Louisiana Not Accepted Report.

After 31 days, the claim that did not crossover can be submitted electronically in the 837 format (if  ending through a clearinghouse, verify your clearinghouse allows the electronic submission of these claims) or on a paper claim form (CMS-1500 or UB-04) along with a copy of the Medicare remittance advice.

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