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Blue Plans Move to Automatic Crossover for all Medicare Claims

Claims will be automatically submitted to the secondary Blue Plan. 
Effective January 1, 2008, Medicare will crossover claims to all Blue Plans for services covered under Medigap and Medicare Supplemental products. This will result in automatic claims submission of Medicare claims to the Blue Plan secondary payer, and reduce or eliminate the need for the provider’s office or billing service to submit an additional claim to the secondary carrier.

 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.
  • Include the alpha prefix as part of the member identification number. The alpha prefix is critical for confirming membership and coverage, and key to facilitating prompt payments.

 

When you receive the remittance advice from the Medicare intermediary, determine 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 BCBSTX.
  • If the remittance indicates that the claim was not crossed over, submit the claim to BCBSTX with the Medicare remittance advice.
  • For claim status inquiries, contact BCBSTX at 1-800-451-0287.

 

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 be releasing the claim to the Blue Plan for processing about the same time you receive the Medicare remittance advice. As a result, it may take an additional 14-30 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 creates confusion for the member.

 

Who do I contact if I have questions? 
If you have questions, please call BCBSTX at 1-800-451-0287.