BlueCard move to automatic crossover for all Medicare claims:
All claims will be automatically submitted to the secondary payor
Effective January 1, 2008, all Blue Plans will crossover Medicare claims for services covered under Medigap and Medicare Supplemental products. This will result in automatic claims submission of Medicare claims to the Blue secondary payor, and it will reduce or eliminate the need for the provider’s office or billing service to submit an additional claim to the secondary carrier. Additionally, with all Blue Plans participating in this process, Medicare claims will crossover in the same manner nationwide.
How do I submit Medicare primary / Blue Plan secondary claims?
- For members with Medicare primary coverage and Blue Plan secondary coverage, submit claims to your Medicare intermediary and/or Medicare carrier.
- When submitting the claim, it is essential that you enter the correct Blue Plan name as the secondary carrier. This may be different from the local Blue Plan. Check the member’s ID card for additional verification.
- Be certain to include the alpha prefix as part of the member identification number. The member’s ID will include the alpha prefix in the first three positions. The alpha prefix is critical for confirming membership and coverage, and crucial in facilitating prompt payments
When you receive the remittance advice from the Medicare intermediary, look to see if the claim has been automatically forwarded (crossed over) to the Blue Plan:
- If the remittance indicates that the claim was crossed over, Medicare has forwarded the claim on your behalf to the appropriate Blue Plan and the claim is in process. There is no need to resubmit that claim to BCBSNC.
- If the remittance indicates that the claim was not crossed over, submit the claim to BCBSNC with the Medicare remittance information.
- In some cases, the member identification card may contain a COBA ID number. If so, be sure to include that number on your claim. COBA is an acronym for coordination of benefits agreement.
- For claim status inquiries, contact BCBSNC.
When should I expect to receive payment?
The claims you submit to the Medicare intermediary will be crossed over to the Blue Plan only after they have been processed by the Medicare intermediary. This process may take up to 14 business days. This means that the Medicare intermediary will release the claim to the Blue Plan for processing at about the same time you receive the Medicare remittance advice. As a result, it may take an additional 14 to 30 business days for you to receive payment from the Blue Plan.
What should I do in the meantime?
If you submitted the claim to the Medicare intermediary/carrier, and haven’t received a response to your initial claim submission, don’t automatically submit another claim. Rather, you should:
- Review the automated resubmission cycle on your claim system
- Wait 30 days
- Check claims status before resubmitting
Sending another claim, or having your billing agency resubmit claims automatically, actually slows down the claim payment process and can create confusion for the member.
What if I have questions?
If you have a question about a specific claim, please call BCBSNC BlueCard customer service at 1-800-487-5522 or for general questions about BlueCard and the automatic crossover process; please contact your local Network Management field office.