February 2, 2009

BC-09-04
HP-09-03
SA-09-04
MS-09-03

HHA-09-03
DC-09-03
ASC-09-03

Secondary To Medicare Claims

Beginning March 1, 2009, Blue Cross and Blue Shield of Kansas (BCBSKS) providers will need to wait 45 days after the Medicare payment/non payment date before submitting an electronic or paper claim to BCBSKS for processing.  To assist the provider in complying with this change, Electronic Data Interchange (EDI) will implement new warning edits for 90 days.  These warning edits are for BCBSKS claims secondary to Medicare being filed prior to 45 days of the Medicare payment/non payment.

By waiting 45 days after the Medicare payment/non payment is received, you are giving the automated cross over process time to work.  You have also saved at least one of the following from occurring.

• A letter sent to you by BCBSKS requesting the Medicare ICN.  
• Duplicate claim submission.
• Adjustments to accounts either positive or negative.
• Duplicate explanation of benefits sent to the insured advising additional information has been requested for complete processing of claims.

In most cases, Medicare will automatically transfer the claim information to BCBSKS for secondary processing.  However, there may be situations that could prevent the automatic crossover process from occurring.  It is important to monitor the Medicare RA to determine whether the claim information crossed over to the secondary payer.  When you find situations where the Medicare RA indicates the claim did not crossover to BCBSKS, please contact your provider representative for help resolving why BCBSKS did not receive the claim.

If a secondary payer claim does need to be submitted,
an electronically submitted claim must reflect:

• the Medicare ICN in the2300 NTE with ADD qualifier,
• the Medicare Adjudication Date in 2330B with a 573 qualifier, and the Medicare Adjudication Date must be equal to or greater than 45 days than the claim filing date.

A paper submitted claim must include:

• the Medicare RA.  Circle or mark the payment information that needs to be processed (limit one request per page).
• If there are multiple payments or patients on the Medicare RA, duplicate that page and submit a separate copy for each case that needs handled.
• Make sure the patient's name and BCBSKS identification number is reflected on the Medicare RA.

Some provider practice management systems automatically create or release a claim to be submitted once the Medicare payment/non payment is posted. If this applies to you, please contact your software vendor and direct them to create or release BCBSKS secondary to Medicare claims only if payment/non payment has occurred 45 days after the Medicare claim information has been posted.  This will help you ensure that you are following these guidelines.

For more detailed information from Electronic Data Interchange (EDI) regarding the edit descriptions, visit their Web site by clicking on the link below.

cg