Duplicate Claims Handling for Medicare Crossover

Since January 1, 2006, all Blue Plans, including Blue Cross and Blue Shield of North Carolina (Blue Cross NC), have been required to process Medicare crossover claims for services covered under Medigap and Medicare Supplemental products through Centers for Medicare & Medicaid Services (CMS).  This has resulted in automatic submission of Medicare claims to the Blue secondary payer to eliminate the need for the provider’s office or billing service to submit an additional claim to the secondary carrier.  Additionally, this has also allowed Medicare crossover claims to be processed in the same manner nationwide.

Effective immediately when a Medicare claim has crossed over, providers are to wait 30 calendar days from the Medicare remittance date before submitting the claim to Blue Cross NC.

The claims you submit to the Medicare intermediary will be crossed over to the Blue Plan only after they have been processed by the Medicare intermediary.  This process may take approximately 14 business days to occur. This means that the Medicare intermediary will be releasing the claim to the Blue Plan for processing about the same time you receive the Medicare remittance advice. As a result, upon receipt of the remittance advice from Medicare, it may take up to 30 additional calendar days for you to receive payment or instructions from the Blue Plan.

Providers should continue to submit services that are covered by Medicare directly to Medicare.  Even if Medicare may exhaust or has exhausted, continue to submit claims to Medicare to allow for the crossover process to occur and for the member’s benefit policy to be applied.

Medicare primary claims, including those with Medicare exhaust services that have crossed over and are received within 30 calendar days of the Medicare remittance date or with no Medicare remittance date will be returned by Blue Cross NC.

Commonly Asked Questions:

How do I submit Medicare primary / Blue Plan secondary claims?

• For members with Medicare primary coverage and Blue Plan secondary coverage, submit claims to your Medicare intermediary and/or Medicare carrier.
• When submitting the claim, it is essential that you enter the correct Blue Plan name as the secondary carrier.  This may be different from the local Blue Plan.  Check the member’s ID card for additional verification. 
• Be certain to include the alpha prefix as part of the member identification number.  The member’s ID will include the alpha prefix in the first three positions.  The alpha prefix is critical for confirming membership and coverage, and key to facilitating prompt payments.

When you receive the remittance advice from the Medicare intermediary, look to see if the claim has been automatically forwarded (crossed over) to the Blue Plan:

• If the remittance indicates that the claim was crossed over, Medicare has forwarded the claim on your behalf to the appropriate Blue Plan and the claim is in process.  There is no need to resubmit that claim to Blue Cross NC.
• If the remittance indicates that the claim was not crossed over, submit the claim to Blue Cross NC with the Medicare remittance advice. 
• In some cases, the member identification card may contain a COBA ID number.  If so, be certain to include that number on your claim.
• For claim status inquiries, contact IPP BlueCard® Customer Service at 1.800.487.5522.

When should I expect to receive payment?

The claims you submit to the Medicare intermediary will be crossed over to the Blue Plan only after they have been processed by the Medicare intermediary.  This process may take approximately 14 business days to occur. This means that the Medicare intermediary will be releasing the claim to the Blue Plan for processing about the same time you receive the Medicare remittance advice. As a result, upon receipt of the remittance advice from Medicare, it may take up to 30 additional business days for you to receive payment or instructions from the Blue Plan.

What should I do in the meantime?

If you submitted the claim to the Medicare intermediary/carrier, and haven’t received a response to your initial claim submission, do not automatically submit another claim.  Rather, you should:

• Review the automated resubmission cycle on your claim system.
• Wait 30 calendar days from receipt of the Medicare Remittance advice.
• Check claims status before resubmitting.

Sending another claim, or having your billing agency resubmit claims automatically, actually slows down the claim payment process and creates confusion for the member.

Who do I contact if I have questions?

If you have questions, please contact IPP BlueCard® Customer Service at 1.800.487.5522.