Thursday, March 3, 2011

Medicare and Medicaid cross over claims denial


When a recipient has both Medicare and Medicaid coverage, a claim must be filed with Medicare first. The provider should indicate on the claim form to Medicare that the individual is eligible for Medicaid by checking “Medicaid,” in Field #1 and entering “Missouri Medicaid” and the recipient’s Medicaid number in Field #9a of the HCFA-1500 claim form. For Medicare Part B claims submitted on the HCFA-1500, providers should enter their Medicaid provider number in Field #33. After making payment, the Medicare carrier or intermediary forwards the claim information to Medicaid for payment of deductible and coinsurance amounts. (Reference Section 16.5 for instructions to bill Medicaid when Medicare denies a service.)
The Medicaid payment of a deductible and/or coinsurance appears on the provider’s Medicaid Remittance Advice (RA). There is an example of how a crossover payment is posted on an RA in Section 17 of this manual.

Some crossover claims cannot be processed in the usual manner for one of the following reasons:

• The carrier does not send crossovers to Missouri Medicaid.
• The provider did not indicate on his claim to Medicare that the beneficiary was eligible for Missouri Medicaid.
• The recipient information on the crossover claim does not match the fiscal agent’s recipient file.
• The provider’s Medicare ID number is not on file in the Division of Medical Services’ provider files.
Crossover claims that cannot be processed in the usual manner must be paper-filed by the provider.

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