Medicare Crossover Consolidation
(More Claims Will Be Automatically Submitted to the Secondary Payer)
How do I submit Medicare primary/Blue Plan secondary claims?
For members with Medicare primary coverage and Blue Plan secondary coverage, submit claims to your Medicare intermediary and/or Medicare carrier. When submitting the claim, it is essential that you enter the correct Blue Plan name as the secondary carrier. This may be different from BCBSGa. Check the member’s ID card for additional verification. The member’s 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.
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:
| If the remittance indicates 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. There is no need to resubmit that claim to BCBSGa. |
| If the remittance indicates that the claim was not crossed over, submit the claim to BCBSGa with the Medicare remittance advice. |
| For claim status inquiries, contact BCBSGa at 1-800-628-3988 |
What is Medicare crossover consolidation and how does it affect my claim processing?
To simplify and streamline claim submission, the Centers for Medicare and Medicaid Services (CMS) is now consolidating its claim crossover process under a special Coordination of Benefits Contractor (COBC) by means of the Coordination of Benefits Agreement (COBA). Under this program, the COBC will automatically forward most Medicare claims to the secondary payer, eliminating the need to separately bill the secondary payer.
Blue Plans are now implementing the Medicare crossover consolidation process System-wide, and will continue to do so over the next few months. Once the consolidated crossover process is fully implemented, you should experience an increased level of "one-stop" billing for your Medicare primary claims.
This change may affect the timing of the secondary payment from the Blue Plan. 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 up to 14 business days. 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, it may take an additional 14-30 business days for you to receive payment from the Blue Plan.
What should I do in the meantime?
If you submitted the claim to the Medicare intermediary/carrier, and haven’t received a response to your initial claim submission, don’t automatically submit another claim. Rather, you should:
| Review the automated resubmission cycle on your claim system.|
| Wait 30 days.|
| Check claims status before resubmitting.|
Sending another claim, or having your billing agency resubmit claims automatically, actually slows down the claim payment process and creates confusion for the member.
Who do I contact if I have questions?
If you have questions, please call BCBSGA at 1-800- 628-3988.