Author Topic: Crossover  (Read 733 times)

dfranklin

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Crossover
« on: January 30, 2010, 04:12:42 AM »
I wasn't really sure what crossover was until I think it happened.  I guess it is where Medicare will automatically send the claim to the secondary for payment consideration?

The reason I am confused is I have a patient that I had submitted to Medicare.  Then all of a sudden I received a payment from BCBS.  The confusing part is I don't even have a 2nd down for this patient and had no idea that she had BCBS coverage.  Does Medicare know about other coverages if we don't inform them on the claim?

Is this how it works?  Should I add BCBS as a 2nd for the patient for future claims? 

If Medicare sends some claims over to some carriers then how do we know this and which ones?  Otherwise we will end up submitting to the 2nd probably before we are notified of the crossover and duplicate claims will hit the 2nd carrier.

Thanks!

Don

Michele

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Re: Crossover
« Reply #1 on: January 30, 2010, 11:10:45 AM »
I wasn't really sure what crossover was until I think it happened.  I guess it is where Medicare will automatically send the claim to the secondary for payment consideration?

Yes


The reason I am confused is I have a patient that I had submitted to Medicare.  Then all of a sudden I received a payment from BCBS.  The confusing part is I don't even have a 2nd down for this patient and had no idea that she had BCBS coverage.  Does Medicare know about other coverages if we don't inform them on the claim?

Yes, Medicare will have a patient's secondary info on file.  Even if it isn't reported on a claim, if it is in their file then they forward it automatically.


Is this how it works?  Should I add BCBS as a 2nd for the patient for future claims?

You should inform the provider that the patient has secondary insurance and ask them to get a copy of the card at the next visit.



If Medicare sends some claims over to some carriers then how do we know this and which ones?  Otherwise we will end up submitting to the 2nd probably before we are notified of the crossover and duplicate claims will hit the 2nd carrier.

It is indicated on the Medicare EOB when a claim is forwarded.


Michele
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