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Friday, March 18, 2011

Railroad cross over claim tips

CROSSOVER CLAIMS FOR RAILROAD BENEFICIARIES

Part B Medicare claims for Railroad beneficiaries are processed by United HealthCare.
Claims for the deductible and coinsurance portion can be electronically crossed over to Missouri Medicaid for processing when the individual is eligible for Missouri Medicaid or MC+.

Some crossover claims cannot be processed electronically. Review the following for reasons that claims do not cross over electronically.

• The provider did not indicate on the claim to United HealthCare 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. Providers must notify the DMS provider enrollment unit of their Medicare ID number. In order for the RR beneficiary claim to crossover, the provider must submit the following information to the Provider Enrollment Unit (PEU).

1) Documentation of the United HealthCare Part B provider number (RA or approval letter);
2) Medicaid provider number; and
3) Medicaid provider name

Crossover claims that cannot be processed in the usual manner must be paper-filed.

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