Cross Over Claims

Enter your billing questions or comments here.
ytyutyunik

Cross Over Claims

Post by ytyutyunik » Thu Feb 28, 2013 12:56 pm

Medicare (primary insurance) crosses over claims to Medicaid (secondary). Medicaid doesn't receive these claims.
What could be the reason? Medicare doesn't receive any rejection from Medicaid. Medicaid saying no claims are received from Medicare. Contacted both insurances multiple times. NO solutions found. Any idea?
Thank you

User avatar
Gavin Walker
Posts: 4625
Joined: Wed Apr 04, 2007 10:11 pm
Location: Springfield, MO
Contact:

Re: Cross Over Claims

Post by Gavin Walker » Thu Feb 28, 2013 3:14 pm

How do you submit the claims to Medicare?
Gavin Walker
Walker Tek Solutions, LLC
417-890-6777 x0
fax: 417-763-6386

ytyutyunik

Re: Cross Over Claims

Post by ytyutyunik » Thu Feb 28, 2013 3:20 pm

Electronically.

User avatar
Gavin Walker
Posts: 4625
Joined: Wed Apr 04, 2007 10:11 pm
Location: Springfield, MO
Contact:

Re: Cross Over Claims

Post by Gavin Walker » Fri Mar 01, 2013 9:38 am

Are you sending claims direct to Medicare or are you using a clearinghouse? Are you using Revenue Management? Are these Print Image claims, ANSI 4010, or ANSI 5010 claims?

ytyutyunik

Re: Cross Over Claims

Post by ytyutyunik » Fri Mar 01, 2013 2:59 pm

Using Revenue Management to send claims through Clearing House to Medicare. Apparently can print the claims, hadn't done that yet.

User avatar
Gavin Walker
Posts: 4625
Joined: Wed Apr 04, 2007 10:11 pm
Location: Springfield, MO
Contact:

Re: Cross Over Claims

Post by Gavin Walker » Fri Mar 01, 2013 4:45 pm

You can simply send your secondary claims through the same clearinghouse using Revenue Management. On the list of things to do is to enhance the way crossover claims work in Revenue Management.

Here are the triggers that are supposed to cause Revenue Management to send secondary payer info on the primary claim for crossovers:

1. Check Crossover Claim on the Policy 2 tab of the case.
2. On the secondary Insurance Carrier EDI/Eligibility tab, enter the Medigap number in the EDI Extra 1/Medigap field.

ytyutyunik

Re: Cross Over Claims

Post by ytyutyunik » Mon Mar 04, 2013 11:56 am

Do you have EDI Extra 1/Medigap for Medicaid by any chance, my Clearing House doesn't have that information.
Thank you

User avatar
Gavin Walker
Posts: 4625
Joined: Wed Apr 04, 2007 10:11 pm
Location: Springfield, MO
Contact:

Re: Cross Over Claims

Post by Gavin Walker » Mon Mar 04, 2013 9:25 pm

You will have to go to your Medicare intermediary to get the list of Medigap payer ids. Normally you can find this on their website.
Gavin Walker
Walker Tek Solutions, LLC
417-890-6777 x0
fax: 417-763-6386

ytyutyunik

Re: Cross Over Claims

Post by ytyutyunik » Tue Mar 05, 2013 2:53 pm

Thank you very much. Will try

abdulrahman
Posts: 2
Joined: Sat Mar 09, 2013 7:51 am

Re: Cross Over Claims

Post by abdulrahman » Sat Mar 09, 2013 8:01 am

Gavin Walker wrote:How do you submit the claims to Medicare?
medicare farwoded to bs-ca directly

abdulrahman
Posts: 2
Joined: Sat Mar 09, 2013 7:51 am

Re: Cross Over Claims

Post by abdulrahman » Sat Mar 09, 2013 8:03 am

abdulrahman wrote:
Gavin Walker wrote:How do you submit the claims to Medicare?
medicare farwoded to bs-ca directly
if claim not on file what we can do?

User avatar
Gavin Walker
Posts: 4625
Joined: Wed Apr 04, 2007 10:11 pm
Location: Springfield, MO
Contact:

Re: Cross Over Claims

Post by Gavin Walker » Sat Mar 09, 2013 2:47 pm

I assume you are saying Medicare forwarded the claim to a secondary payer but the secondary payer was not setup in Medisoft. What you can do is go ahead and add the secondary payer information to the case and make sure you click Crossover Claim on the Policy 2 tab. Then in Transaction Entry click Update All.

ytyutyunik

Re: Cross Over Claims

Post by ytyutyunik » Mon Mar 11, 2013 1:03 pm

So, I wasn't able to find Medigap for Medicaid. I contacted both Medicare and Clearing House.

User avatar
Gavin Walker
Posts: 4625
Joined: Wed Apr 04, 2007 10:11 pm
Location: Springfield, MO
Contact:

Re: Cross Over Claims

Post by Gavin Walker » Mon Mar 11, 2013 4:26 pm

Who is your Medicare intermediary?

ytyutyunik

Re: Cross Over Claims

Post by ytyutyunik » Wed Mar 13, 2013 11:14 am

NGS

Post Reply