July 10, 2013

HHA-13-5
DC-13-5
ASC-13-6
MS-13-7

BC-13-7
SA-13-5
HP-13-5

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:

Medicare Primary Duplicate Claims and Pricing Requirement

Since January 1, 2006, all Blue Plans have been required to process Medicare crossover claims for services covered under Medigap and Medicare Supplemental products through Centers for Medicare & Medicaid Services (CMS). This has resulted in automatic submission of Medicare claims to the Blue secondary payer to eliminate the need for the provider’s office or billing service to submit an additional claim to the secondary carrier. Additionally, this has also allowed Medicare crossover claims to be processed in the same manner nationwide.

Effective Aug. 19, 2013 when a Medicare claim has crossed over, providers are to wait 30 calendar days from the Medicare remittance date before submitting the claim to Blue Cross and Blue Shield of Kansas (BCBSKS).

The claims you submit to the Medicare intermediary will be crossed over to the Blue Plan only after they have been processed by the Medicare intermediary. This process may take approximately 14 business days to occur. This means that the Medicare intermediary will be releasing the claim to the Blue Plan for processing about the same time you receive the Medicare remittance advice. As a result, upon receipt of the remittance advice from Medicare, it may take up to 30 additional calendar days for you to receive payment or instructions from the Blue Plan.

Providers should continue to submit services that are covered by Medicare directly to Medicare. Even if Medicare may exhaust or has exhausted, continue to submit claims to Medicare to allow for the crossover process to occur and for the member’s benefit policy to be applied.

Medicare primary claims, including those with Medicare exhaust services, which have crossed over and are received within 30 calendar days of the Medicare remittance date or with no Medicare remittance date, will be rejected by BCBSKS.

Commonly Asked Questions

How do I submit Medicare primary / Blue Plan secondary claims?

When you receive the remittance advice from the Medicare intermediary, look to see if the claim has been automatically forwarded (crossed over) to the Blue Plan:

When should I expect to receive payment?

The claims you submit to the Medicare intermediary will be crossed over to the Blue Plan only after they have been processed by the Medicare intermediary. This process may take approximately 14 business days to occur. This means that the Medicare intermediary will be releasing the claim to the Blue Plan for processing about the same time you receive the Medicare remittance advice. As a result, upon receipt of the remittance advice from Medicare, it may take up to 30 additional business days for you to receive payment or instructions from the Blue Plan.

What should I do in the meantime?

If you submitted the claim to the Medicare intermediary/carrier, and have not received a response to your initial claim submission, do not automatically submit another claim. Instead, you should:

Sending another claim, or having your billing agency resubmit claims automatically, will  slow  down the claim payment process and create confusion for the member.

Who do I contact if I have questions?

If you have questions, please call Customer Service at 1-800-432-3990 or (785) 291-4180.

 

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