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October 2009 UB-04 Medicare Crossover Claims Presented by EDS Provider Relations.

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Presentation on theme: "October 2009 UB-04 Medicare Crossover Claims Presented by EDS Provider Relations."— Presentation transcript:

1 October 2009 UB-04 Medicare Crossover Claims Presented by EDS Provider Relations

2 2/ October 2009 UB-04 Medicare Crossover Claims Agenda Session Objectives Crossover Claim – Defined Automatic Crossover Claim filing limit Claims partially paid by Medicare How To Bill A Crossover Claim Helpful Tools

3 3/ October 2009 UB-04 Medicare Crossover Claims Session Objectives To have a general understanding of the following: Definition of a crossover claim Where to insert crossover information on the UB-04 claim form Where to input crossover information on Web interChange claims

4 4/ October 2009 UB-04 Medicare Crossover Claims Crossover Claim - Defined The term, crossover claim applies when a member has Medicare as the primary insurance, and: The Medicare coverage is from traditional Medicare, not one of the Medicare Replacement (or Medicare HMO) plans Medicare issued a payment of any amount, or the entire payment was applied to the deductible A claim is not a crossover claim when: The members primary insurance is not traditional Medicare Medicare denied the entire claim Medicare benefit exhaust claim

5 5/ October 2009 UB-04 Medicare Crossover Claims Automatic Crossover Following are some of the reasons why claims fail to cross over from Medicare automatically The Medicare intermediary is not National Government Services (NGS) or is not an intermediary that has a partnership agreement with EDS Ambulatory surgical center (ASC) claims billed to Medicare on a CMS-1500 claim form with the SG modifier Data errors on the crossover file –Examples include incorrect Social Security number (SSN) or spelling of member name Why Claims Do Not Cross Over Automatically

6 6/ October 2009 UB-04 Medicare Crossover Claims Claim Filing Limit The standard filing limit for Medicaid claims is one year from the date of service Crossover claims are not subject to the one-year filing limit –Crossover claims may be submitted and processed irrespective of the age of the claim

7 7/ October 2009 UB-04 Medicare Crossover Claims Claims Partially Paid by Medicare When Medicare allows only some of the services on the claim: –Only the Medicare-allowed services apply to crossover logic These services should be billed to Medicaid separately from the Medicare-denied services Providers should not send the Medicare Remittance Notice (MRN) to Medicaid when billing these services –Only the Medicare-allowed services are exempt from the one-year filing limit –Services denied by Medicare are subject to the one- year filing limit These services should be billed separately to Medicaid with a copy of the MRN

8 8/ October 2009 UB-04 Medicare Crossover Claims How To Bill A Crossover Claim Identify Medicare Remittance Notice (MRN) information as follows: –Value Code A1 – Medicare deductible amount –Value Code A2 – Medicare co-insurance amount –Value Code 06 – Medicare blood deductible amount –Value Code 80 – IHCP covered days Form Field 39

9 9/ October 2009 UB-04 Medicare Crossover Claims How To Bill A Crossover Claim Field 50a - Enter the word Medicare Field 54a – Enter the amount paid by Medicare Form Fields 50a through 54a

10 10/ October 2009 UB-04 Medicare Crossover Claims How to Bill a Crossover on Web interChange From the Claim Submission Menu, select Institutional or Outpatient Crossover Complete the claim information Select Benefits Information to enter the Coordination of Benefits information Complete the following fields: –Payer ID (00130 for Part A; for Part B) –Payer Name –TPL/Medicare Paid Amount –First Name –Last Name –Primary ID –Relationship Code –Gender –Date of Birth –Claim Filing Code (MA for Part A; MB for Part B)

11 11/ October 2009 UB-04 Medicare Crossover Claims After entering the Coordination of Benefits information at the header level –Click Save Benefits –Click Save and Close –Submit claim It is not necessary to enter coordination of benefits information at the detail level How to Bill a Crossover on Web interChange

12 12/ October 2009 UB-04 Medicare Crossover Claims Web interChange – Claims Processing Menu

13 13/ October 2009 UB-04 Medicare Crossover Claims Institutional Claim

14 14/ October 2009 UB-04 Medicare Crossover Claims Coordination of Benefits

15 15/ October 2009 UB-04 Medicare Crossover Claims Coordination of Benefits

16 16/ October 2009 UB-04 Medicare Crossover Claims Helpful Tools IHCP Web site at IHCP Provider Manual, Chapter 8, Section 2 (Web, CD-ROM, or paper) Customer Assistance – , or –(317) in the Indianapolis local area Written Correspondence –P.O. Box 7263 Indianapolis, IN Provider Relations field consultant Avenues of Resolution

17 17/ October 2009 UB-04 Medicare Crossover Claims Questions

18 October 2009 EDS and the EDS logo are registered trademarks of Hewlett-Packard Development Company, LP. HP is an equal opportunity employer and values the diversity of its people. © 2009 Hewlett-Packard Development Company, LP. Office of Medicaid Policy and Planning (OMPP) 402 W. Washington St, Room W374 Indianapolis, IN EDS, an HP Company 950 N. Meridian St., Suite 1150 Indianapolis, IN 46204


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