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Medical Policy, Clinical UM Guidelines, and Pre-Cert Requirements

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Quick Tips for Medicare Claims Filing

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In BCBSGa’s ongoing efforts to better service you, we are providing information to help make filing your Medicare claims easier. If you are a provider who accepts Medicare assignment and renders care to members from other Blue Plans, please note the following Q&As: 
What are Blue Cross and/or Blue Shield Medicare-related claims?
These are claims for coverage that is secondary/supplemental to Medicare and is provided by a Blue Cross and/or Blue Shield Plan.  
Examples include: 
Medigap (also called Medicare Supplemental, Medicare Complementary and Medicare Extended)
Medicare Carve-out
 
How do I identify a member with a Medicare-related Policy?
Often, members will carry more than one identification (ID) card. Member’s current ID card, when Medicare is the primary payer, should be a standard Medicare card without a Blue Cross and/or Blue Shield logo. Members may also present a separate ID card with a Blue Cross and/or Blue Shield logo for Medicare secondary coverage. 
Where do I submit Blue Cross and/or Blue Shield Medicare-related claims?
If the member has secondary coverage, submit the claim to BCBSGa which is the local Blue Plan. When Medicare is primary, submit claims to your Medicare intermediary and/or Medicare carrier.  
It is essential that you enter the correct Blue Plan name as the secondary carrier, which may be different from BCBSGa, the local Blue Plan. Check the member’s ID card for additional verification. The member ID will include the alpha prefix in the first three positions. The alpha prefix is critical for confirming membership and coverage and key to facilitating prompt payments.  
After receipt of the explanation of payment, or Medicare Remittance Notice from Medicare, look to see if the claim has been automatically forwarded (crossed-over).  
If the remittance shows that the claim was crossed-over, Medicare has forwarded the claim on your behalf to the appropriate Blue Plan and the claim is in process. You can make claim status inquiries through BCBSGa.
If the claim was not crossed-over, submit the claim to BCBSGa with the MRN. For claim status inquiries, contact BCBSGa.
 
Reminders for Remittance Advice:
Do not submit Medicare-related claims to BCBSGa before receiving a Medicare Remittance Notice from the Medicare intermediary and/or Medicare carrier. Duplicate claims submissions can delay claim processing and create administrative inefficiencies for you and the insurance plan. 
If you have any questions, please contact 1-800-628-3988.    
 
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Blue Cross and Blue Shield of Georgia, Inc. and Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.