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Friday, March 25, 2011

How to submit secondary claim if EOB has more than one patient claim

MULTIPLE CLAIMS

If more than one Medicare/Medicaid recipient is shown on the same RA/EOMB, then a separate paper crossover claim must be submitted for each recipient. For example, the names of John Jones and Robert Smith, who are both Medicaid eligible, appear on the same RA/EOMB. If the provider needs to file a paper crossover claim for both of them, the provider must complete a Part B sticker for John Jones and affix it to a copy of the RA/EOMB and complete another Part B sticker for Robert Smith and affix it to another copy of the RA/EOMB.

Sometimes the same Medicaid recipient’s name may appear multiple times on the RA/EOMB; each name repeated represents a separate Medicare claim. This is usually the result of the provider having submitted multiple claims to Medicare for this person. In this situation, a separate paper crossover claim must be submitted to Medicaid for each Medicare claim. As in the above example, the provider must complete a Part B sticker for each Medicare claim and affix it to a copy of the RA/EOMB.

It is not acceptable to affix two Part B stickers on one RA/EOMB whether each sticker is for the same or a different recipient. When there are several claims shown on one RA/EOMB, it is recommended that the provider highlight by circling or using an asterisk to indicate the Medicare claim being submitted to Medicaid.

MULTIPLE LINES PER CLAIM

Frequently several lines representing different dates of service appear on an RA/EOMB for one Medicare claim. Only one paper crossover claim needs to be submitted to Medicaid, but it is important that the “From” and “Through” fields on the Part B sticker are inclusive of all dates of service shown for that claim. This is applicable even if the service for the “From” or “Through” date was denied. A separate claim must be billed for denied services. (Reference Section 16.5.)

For example, if the RA/EOMB indicates dates of service 05/02/95, 04/30/95, 05/14/95, and 05/23/95 for one claim, the provider must enter 04/30/95 in the “From” field and 05/23/95 in the “Through” field.

16.3.C MULTIPLE PAGES OF AN RA/EOMB
Sometimes Medicare needs to continue the claim information on a second page of the RA/EOMB. The provider needs to submit only one paper crossover claim to Medicaid showing inclusive dates of services as explained above, but the second page of the RA/EOMB must be stapled to the first page with the Part B sticker affixed to one of the pages.

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