March 16, 2006

BC-06-06
HP-06-04
SA-06-04

HHA-06-04
DC-06-04

Including the following providers who bill services to Medicare intermediaries:

• Community Mental Health Centers
• Comprehensive Outpatient Rehabilitation Facilities
• Physical Therapy/Speech-Language Pathology Providers
• Rural Health Clinics
• Skilled Nursing Facilities

Community Mental Health Clinics, Comprehensive Outpatient Rehabilitation Facilities, Physical Therapy/Speech-Language Pathology Providers, Rural Health Clinics, Skilled Nursing Facilities

Medicare Claims – Consolidated Crossover Process
(BCBS Claims Secondary to Medicare)

On March 27, 2006 Blue Cross and Blue Shield of Kansas is scheduled to convert to the new Medicare consolidated claim crossover process.  Under this program, the national Medicare Coordination of Benefits Contractor (COBC) will automatically forward payment information about most Medicare claims to the secondary payer, eliminating the need for providers to separately bill the secondary payer.

While this process is new to BCBSKS, it has previously been implemented by other BCBS plans.  Therefore, Kansas' providers who have treated out-of-area Blue Plan members that have Medicare as their primary payer may already be familiar with the process.

How to submit Medicare primary/Blue Plan secondary claims.

For members with Medicare primary and Blue Plan secondary coverage,

• Submit claims to your Medicare intermediary or carrier.
• On the Medicare claim, be sure to enter the correct Blue Plan name as the secondary payer.  This may not be BCBSKS and you can verify the plan name by checking the member's ID card.
• Report the member's BCBS identification number including the alpha prefix.  The alpha prefix appears in the first three positions of the ID number and is critical in confirming the member's coverage.

When you receive the Medicare remittance advice, look to see if the claim was automatically crossed over.

• If the Medicare RA indicates that the claim crossed over, the provider does not need to resubmit the claim.
• If the Medicare RA indicates that the claim did not crossover, submit the claim to BCBSKS with the Medicare remittance advice.  (All claims for any Blue Plan member should be sent to BCBSKS.)

NOTE:  There may be times when the Medicare RA shows the claim crossed over but actually didn't.  When this happens, Medicare will send a separate notice showing the internal/document control number, HIC number, medical record number, patient control number, beneficiary name, date of service, the date the claim was processed and will state: "The above claim(s) was/were not crossed over to the patient's supplemental insurer due to a claim data errors".  If this occurs, submit the claim to BCBSKS with the Medicare remittance advice. (See the last section of this newsletter for complete instructions on how to submit a paper request to BCBSKS for payment of Medicare balances.)

How soon will the Blue Plan pay crossover claims?

The COBC will cross over claim information to secondary payers AFTER Medicare pays the claim.  (This includes satisfying the Medicare claim payment floor.)  It may then take an additional 14-30 business days for providers to receive payment from the Blue Plan.

What should I do in the meantime?

If you submitted a Medicare claim and haven't received a response,

• Don't automatically submit another claim.
• Check the online Medicare claim system to determine when Medicare paid.
• Use the BCBSKS Web site to check the status of the crossover claim.

If Medicare adjusts a claim, will that information cross over?

Starting off, no Part A or Part B adjustments will cross over electronically from Medicare to BCBSKS.   This is temporary and after we have a chance to complete testing and make sure everything is working all right, we’ll include adjustments in the crossover process.  A news bulletin will be posted to the BCBSKS Web site when this occurs.

If I have questions, whom do I call?

After checking the status of the claim on the BCBSKS Web site, if you still have questions, call:

          BCBSKS customer service center:          1-800-432-3990

Learn more about the CMS Crossover Process.

• Medicare Learning Network Matters SE0504 CMS Consolidation of the Claims Crossover Process http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0504.pdf
• Medicare Learning Network Matters MM3709 Coordination of Benefits Agreement Detailed Error Report Notification Process http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM3709.pdf

How to Submit a Paper Request to BCBSKS for Payment of Medicare Balances.

If a provider needs to submit a PAPER request to BCBSKS for the payment of Medicare balances, here's what you need to do:

• Send a copy of the Medicare remittance advice that clearly reflects:
• Provider name and address
• Medicare provider number
• Blue Cross provider number

NOTE FOR CMHC, CORF, PT/SP, RHC:  when you became Medicare certified and began billing services to Medicare using the UB-92 billing format, BCBSKS assigned you a Blue Cross provider number to be used ONLY for paying claims secondary to Medicare.  This Blue Cross number is entirely different than your regular Blue Shield number and the two are NOT INTERCHANGEABLE.

• On the Medicare remittance advice, circle or bracket the payment information that needs to be processed (limited to one request per page).

• If you have multiple payments or patients on the same page of the remittance advice that need to be processed by BCBSKS, you will need to duplicate that page and submit a separate copy for EACH case that needs handled.

• Make sure the patient's name and BCBS identification number is reflected on the remittance advice.

• Circle the deductible/coinsurance fields on the Medicare remittance advice.

• Include a copy of a UB-92 claim form (or identifiable facsimile) that reflects the codes and charges billed to Medicare.

NOTE FOR CMHC, CORF, PT/SP, RHC:  You can include either a UB-92 claim form (or identifiable facsimile) or a CMS 1500 claim form that reflects the codes and charges billed to Medicare.

• Before submitting a paper claim, BCBSKS suggests that you use the claim status section of the BCBSKS Web site to see if the claim has already been processed.