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Attention Rural Health Clinics: Important Notice About Medicare Crossover Claims

Effective March 15, 2007, Blue Cross and Blue Shield of North Carolina "BCBSNC" will no longer accept claims from Rural Health Clinics as part of the Medicare crossover process for coordination of Medicare primary benefits.

Beginning March 15, 2007, all Rural Health Clinic claims must be reported as an 837 Professional claim or on an HCFA-1500 paper claim form (paper being the least preferred) with the required Medicare primarily Explanation of Benefits "EOB" payment information included. BCBSNC must receive the Medicare primary payment information to accurately process Medicare primary claims for a BCBSNC member's secondary benefits.

BCBSNC has discovered a duplicate claims reporting issue and subsequent provider overpayment pattern originating from a process change in the handling of Medicare crossover claims. This process change occurred on May 1, 2006, when Group Health Incorporated "GHI" became the Medicare intermediary administering the Medicare crossover program. Prior to the May 1, 2006 transition to GHI, Rural Health Clinics were excluded from processing via the Medicare Crossover file. After the implementation of GHI as the Medicare intermediary, claims from Rural Health Clinics were no longer excluded from the Coordination of Benefits Agreement "COBA" program. However, Rural Health Clinics had previously been instructed by BCBSNC to file 837 Professional claims or HCFA-1500 paper claims for Medicare primary patients, directly to BCBSNC along with the appropriate Medicare primary payment information. The changed inclusion of Rural Health Clinic claims into the COBA agreement resulted in BCBSNC processing duplicate claims from Rural Health Clinics that were received by direct submission and electronically via the Medicare Crossover process.

We apologize for any inconvenience experienced from our temporarily processing Rural Health Clinic claims received in the crossover process. If you have any questions regarding this issue or if you need assistance with claims filing instruction, please contact your local BCBSNC Network Management field office.