July 14, 2011

HHA-11-07
DC-11-06
ASC-11-08

BC-11-08
HP-11-06
SA-11-06
MS-11-08

To:

All Blue Cross and Blue Shield of Kansas Contracting Providers

From:

Connie Winkley – Education/Communication Coordinator
Institutional Provider Relations
Blue Cross and Blue Shield of Kansas, Inc.
An Independent Licensee of the Blue Cross and Blue Shield Association

Subject:

Automatic Crossovers from Medicare for Mass Adjustments

Recently Medicare has initiated a series of mass adjustments, many of which resulted in adjustment amounts of approximately $1.00.  While it has been administratively challenging and costly to process the multitude of low-dollar claims the Medicare mass adjustments have created, Blue Cross and Blue Shield of Kansas has already processed a very large volume of such claims.  The Blue Cross and Blue Shield Association Board of Directors had an opportunity to discuss the significant issues associated with this matter recently. The Board determined that it is particularly important that there be uniformity among the various Blue Plans in the approach to handling these mass adjustments. Since CMS allows adjustments to be excluded from the automatic crossover process, and given the unique problems created for both payers and providers in administering and reconciling these high volume/low dollar adjustments, the Blue Cross and Blue Shield Association Board voted to require all Blue Plans to initiate the process to amend their Coordination of Benefits Agreements (COBA) with CMS, for local and BlueCard claims, to exclude Medicare crossover mass adjustments from directly crossing over from CMS to the Blue Plan.

Therefore, effective July 15, 2011, we will no longer accept (nor will other Blue Plans) automatic crossovers for Medicare mass adjustments. We will continue to process the adjustments that are currently in-house and those received until the July 15 effective date.  If providers want to have any of their remaining Medicare crossover claims adjusted after July 15 or in the future when Medicare mass adjustments occur, they will need to submit the claim for the adjustment through the standard claim filing process. 

It is important for providers to monitor their Medicare remittance advice to determine if the claim information crossed to the secondary payer.

PLEASE NOTE:

Blue Cross and Blue Shield of Kansas will continue to receive and process mass adjustments for Federal Employee Program (FEP), as well as regular adjustments initiated by providers for all lines of business.

Regular crossover for secondary claims is not affected by this change to the crossovers for Medicare mass adjustments.

cw