1. UB-04 Medicare Crossover Claims
Presented by EDS Provider Relations

2. Agenda Session Objectives Crossover Claim – Defined
Automatic Crossover
Claim filing limit
Claims partially paid by Medicare
How To Bill A Crossover Claim
Helpful Tools

3. Session Objectives To have a general understanding of the following:
Definition of a crossover claim
Where to insert crossover information on the UB-04 claim form
Where to input crossover information on Web interChange claims

4. Crossover Claim - Defined
The term, “crossover claim” applies when a member has Medicare as the primary insurance, and:
The Medicare coverage is from traditional Medicare, not one of the Medicare Replacement (or Medicare HMO) plans
Medicare issued a payment of any amount, or the entire payment was applied to the deductible
A claim is not a crossover claim when:
The member’s primary insurance is not traditional Medicare
Medicare denied the entire claim
Medicare benefit exhaust claim

5. Automatic Crossover Why Claims Do Not Cross Over Automatically
Following are some of the reasons why claims fail to cross over from Medicare automatically
The Medicare intermediary is not National Government Services (NGS) or is not an intermediary that has a partnership agreement with EDS
Ambulatory surgical center (ASC) claims billed to Medicare on a CMS-1500 claim form with the SG modifier
Data errors on the crossover file
Examples include incorrect Social Security number (SSN) or spelling of member name

6. Claim Filing Limit
The standard filing limit for Medicaid claims is one year from the date of service
Crossover claims are not subject to the one-year filing limit
Crossover claims may be submitted and processed irrespective of the age of the claim

7. Claims Partially Paid by Medicare
When Medicare allows only some of the services on the claim:
Only the Medicare-allowed services apply to crossover logic
These services should be billed to Medicaid separately from the Medicare-denied services
Providers should not send the Medicare Remittance Notice (MRN) to Medicaid when billing these services
Only the Medicare-allowed services are exempt from the one-year filing limit
Services denied by Medicare are subject to the one-year filing limit
These services should be billed separately to Medicaid with a copy of the MRN

8. How To Bill A Crossover Claim
Form Field 39
Identify Medicare Remittance Notice (MRN) information as follows:
Value Code A1 – Medicare deductible amount
Value Code A2 – Medicare co-insurance amount
Value Code 06 – Medicare blood deductible amount
Value Code 80 – IHCP covered days

9. How To Bill A Crossover Claim
Form Fields 50a through 54a
Field 50a - Enter the word “Medicare”
Field 54a – Enter the amount paid by Medicare

10. How to Bill a Crossover on Web interChange
From the Claim Submission Menu, select Institutional or Outpatient Crossover
Complete the claim information
Select “Benefits Information” to enter the Coordination of Benefits information
Complete the following fields:
Payer ID (00130 for Part A; for Part B)
Payer Name
TPL/Medicare Paid Amount
First Name
Last Name
Primary ID
Relationship Code
Gender
Date of Birth
Claim Filing Code (MA for Part A; MB for Part B)

11. How to Bill a Crossover on Web interChange
After entering the Coordination of Benefits information at the header level
Click Save Benefits
Click Save and Close
Submit claim
It is not necessary to enter coordination of benefits information at the detail level

12. Web interChange – Claims Processing Menu

13. Institutional Claim

14. Coordination of Benefits

15. Coordination of Benefits

16. Helpful Tools Avenues of Resolution
IHCP Web site at
IHCP Provider Manual, Chapter 8, Section 2 (Web, CD-ROM, or paper)
Customer Assistance
, or
(317) in the Indianapolis local area
Written Correspondence
P.O. Box 7263 Indianapolis, IN
Provider Relations field consultant

17. Questions

18. Office of Medicaid Policy and Planning (OMPP)
402 W. Washington St, Room W374
Indianapolis, IN 46204
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