November 23, 2009

C-09-14
HP-09-11
SA-09-13
MS-09-13

HHA-09-11
DC-09-11
ASC-09-12

Cindy Garrison, Education/Communication Coordinator
Institutional Relations
Blue Cross and Blue Shield of Kansas, Inc.
An Independent Licensee of the Blue Cross and Blue Shield Association

Blue Cross Claims Secondary To Medicare: Update

While our expectation is to receive secondary claims to Medicare via the cross over system, this does not always happen.  For various reasons Medicare does not send the claim or Blue Cross and Blue Shield of Kansas (BCBSKS) does not accept the claim.  Some of the reasons the claim does not cross over could be:
*    We do not have the patient loaded as Medicare primary
*    We have the wrong Medicare information loaded (i.e. ID, name, effective date, etc.)
*    Third-party claims

For the above reasons, it is important for providers to monitor their Medicare remittance advice to determine if the claim information crossed to the secondary payer. If the claim crossed over, the Medicare RA will indicate in the REMARK CODES column a MA18. 

Providers should contact customer service (1-800-432-3990) or their provider consultant if the Medicare remittance advice indicates the claim did not crossover to BCBSKS (no MA18) for help in determining why a claim was not received.

On February 2, 2009, BCBSKS notified providers about some changes regarding the electronic claim submission when we are secondary to Medicare.  While providers have been told they can submit these secondary claims to us electronically (after waiting 30 days from the Medicare RA date – this is a change from 45 days), claims are not always processed and are returned to the provider requesting secondary information.  When this happens and you know you submitted the secondary information electronically, please contact

1. Your provider consultant or
2. Cindy Garrison at 785-291-7236 or
3. Nicole Dodds at 785-291-8849

We will research why your claim was returned. 

We apologize for any inconvenience and appreciate your patience.