Medicare Crossover Claims

Conduent MS Medicaid Project

Government Healthcare Solutions

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• CMS-1500 Part B (Traditional Medicare)

• UB-04 Part A (Traditional Medicare)

• Medicare Part C (Advantage/HMO)

• State Mandated Form Part B

• State Mandated Form Part A

Crossover Claim Form Types

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• These claims should be filed on the MS Crossover State Mandated Claim form.

• This form must be used when billing for Medicare Part C Advantage Plans.

• An additional requirement is that a copy of the Medicare EOMB for the billed services must be

attached for all paper crossovers.

• There must be an EOMB for each claim form. (Ex: If there are 9 lines, there should be two claim

forms. An EOMB should be with each claim form.)

Crossover Claim Part C

(Advantage Plans) Professional Claims

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Crossover Claim

Part C

(Advantage Plans) Professional

Claims

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• These claims should be filed on the MS Crossover State Mandated Claim form.

• This form must be used when billing for Medicare Part C Advantage Plans.

• An additional requirement is that a copy of the Medicare EOMB for the billed services must be

attached for all paper crossovers.

• Only one EOMB is required even in the event that there are multiple claim forms (same recipient).

Header information must match the EOMB.

Crossover Claim Part C

(Advantage Plans) Institutional

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Crossover Claim

Part C

(Advantage Plans) Institutional

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CMS 1500 Part B

Traditional Medicare• What information should be

included on the CMS 1500 claim

form?

• Be sure to include any/all

information on the claim as it

was submitted to Medicare.

• Enter “X” in the boxes labeled

“Medicare” and “Medicaid”

• Important fact to remember when

submitting the claim form.

• Do not enter the Medicare Payment

amount in field 29.

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UB04 Part A

Traditional Medicare• What information should be

included on the UB04 claim

form?

• Be sure to include any/all

information on the claim as it

was submitted to Medicare.

• Enter the word

“CROSSOVER” in field 2.• The only TPL payments that

should be reported in field 54 of

the UB04 are those other than

Medicare and Medicaid.

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• EOMB data should be legible

• The Medicare Header Information should be included

• Patient data should be in reference to the beneficiary billed on the claim (A line should be drawn

through any other beneficiaries listed)

• Claim Line Details-Draw a line through line items that have already been paid by Medicaid

Medicare EOMB Tips

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Top Denials

Denial Code Description Resolution

0104 Exact Duplicate ClaimPaid claim already on file. If applicable, the claim will need to

be voided and resubmitted.

0377This HCPC code must be billed with an

NDC

Check the drug code billed and ensure that there

is a rebatable NDC entered on the claim.

0610 EOMB requires review or is missing or invalidThe EOMB should be attached with the claim and have all

claim data.

0630Exact Duplicate Claim – Electronic

Crossover vs. Electronic Crossover

Paid claim already on file. If applicable, the claim

will need to be voided and resubmitted.

0750TPL – Beneficiary has primary insurance coverage – Resubmit

with TPL EOMB

Verify Primary Insurance coverage. Resubmit with primary

EOMB.

3259 Exceeds Timely FilingClaims must be submitted within 180 days from the

Medicare paid date.

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Tertiary Claims should be sent to:

Conduent State Healthcare, LLC

Attn: Rochelle McKinney

P.O. Box 23076

Jackson, MS 39225-3076

Include the claim and both EOMBs

from the primary payers.

Tertiary Claims

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What do I do if my crossover claim does not

crossover from Medicare?

The charges should be submitted to Medicaid

via hardcopy claim or through the Web Portal

along with a copy of the Medicare EOMB.

Can I correct a crossover claim online?

No. The claim should be voided and a new

claim along with the Medicare EOMB should be

submitted to Medicaid for consideration.

Helpful Hints

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If Medicare does not pay the claim but it should have, can I send it to Medicaid to pay?

If Medicare does not pay for a service and they should have, the claim cannot be submitted to

Medicaid without the Medicare EOMB.

Who is considered a dual eligible beneficiary and what part of those claims can I bill to

the patient?

Dually eligible beneficiaries are those eligible for both Medicare and Medicaid. Dual eligible

beneficiaries cannot be billed the difference between what the provider charges and the sum of

the Medicare and Medicaid payment.

Helpful Hints

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Is it a regular Medicaid claim if the service is not covered by Medicare but is covered by

Medicaid?

Yes, if Medicare denies a claim and the procedure code is covered by MS Medicaid, a Medicare

denial is considered to be a Medicaid primary claim.

Is (non-emergency) transportation available for dual eligible beneficiaries?

Claims may be filed for non-emergency transportation for dual eligible beneficiaries for services

not covered by Medicare if the reason for the Medicare denial is other than medical necessity.

What are the timely filing guidelines for crossover claims?

180 days from the Medicare paid date is the timely filing limitation for crossover claims.

Helpful Hints

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Are Part C claims crossed over from

Medicare?

Part C (Medicare Advantage) claims can only

be submitted via paper on the appropriate claim

form along with the Medicare Advantage

EOMB.

Helpful Hints

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1. Do not staple your claims together. Providers can simply place their

attachments behind the associated claims and place them in an

envelope.

2. Sign the claim in ink. The vast majority of the claims are Returned to

the Provider (RTP) because they are not properly signed.

3. Submit requests for Medicaid payment on Crossover form. Providers

should send claims with Medicare Explanation of Benefits (EOB)

showing that payment has been received from Medicare.

4. List the Third Party Liability (TPL) payment in the appropriate field.

For all claims submitted with TPL payments, the payment must be

shown in the prior payments (UB-04) field and the amount paid in

the (CMS-1500) field on the claim.

5. Do not send a stack of claims and one copy of the attachment that

goes with each claim. If there is an attachment that is critical to the

processing of the claim, copy the attachment for each claim and place

it with the associated claim before submitting those claims for

processing.

6. Submit standard 8 x 11 attachments. Strips, cutouts and the like are

not acceptable.

7. Put the bill date on each claim.

8. Place bill types on UB-04s and Crossover Part A forms.

9. Mail or electronically submit your claims. WE DO NOT ACCEPT

FAXED CLAIMS.

Dos and Don’ts

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