March 16, 2006
Including the following providers who bill services to Medicare intermediaries:
|To:||All Blue Cross Contracting Providers|
Community Mental Health Clinics, Comprehensive Outpatient Rehabilitation Facilities, Physical Therapy/Speech-Language Pathology Providers, Rural Health Clinics, Skilled Nursing Facilities
|From:||Donna Bartee, Communications Representative
Blue Cross and Blue Shield of Kansas
An Independent Licensee of the Blue Cross and Blue Shield Association
Medicare Claims – Consolidated Crossover Process
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,
When you receive the Medicare remittance advice, look to see if the claim was automatically crossed over.
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,
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.
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:
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.
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.