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Medicare Crossover Claims
Conduent MS Medicaid Project
Government Healthcare Solutions
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• CMS-1500 Part B (Traditional Medicare)
• UB-04 Part A (Traditional Medicare)
• Medicare Part C (Advantage/HMO)
• State Mandated Form Part B
• State Mandated Form Part A
Crossover Claim Form Types
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• These claims should be filed on the MS Crossover State Mandated Claim form.
• This form must be used when billing for Medicare Part C Advantage Plans.
• An additional requirement is that a copy of the Medicare EOMB for the billed services must be
attached for all paper crossovers.
• There must be an EOMB for each claim form. (Ex: If there are 9 lines, there should be two claim
forms. An EOMB should be with each claim form.)
Crossover Claim Part C
(Advantage Plans) Professional Claims
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Crossover Claim
Part C
(Advantage Plans) Professional
Claims
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• These claims should be filed on the MS Crossover State Mandated Claim form.
• This form must be used when billing for Medicare Part C Advantage Plans.
• An additional requirement is that a copy of the Medicare EOMB for the billed services must be
attached for all paper crossovers.
• Only one EOMB is required even in the event that there are multiple claim forms (same recipient).
Header information must match the EOMB.
Crossover Claim Part C
(Advantage Plans) Institutional
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Crossover Claim
Part C
(Advantage Plans) Institutional
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CMS 1500 Part B
Traditional Medicare• What information should be
included on the CMS 1500 claim
form?
• Be sure to include any/all
information on the claim as it
was submitted to Medicare.
• Enter “X” in the boxes labeled
“Medicare” and “Medicaid”
• Important fact to remember when
submitting the claim form.
• Do not enter the Medicare Payment
amount in field 29.
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UB04 Part A
Traditional Medicare• What information should be
included on the UB04 claim
form?
• Be sure to include any/all
information on the claim as it
was submitted to Medicare.
• Enter the word
“CROSSOVER” in field 2.• The only TPL payments that
should be reported in field 54 of
the UB04 are those other than
Medicare and Medicaid.
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• EOMB data should be legible
• The Medicare Header Information should be included
• Patient data should be in reference to the beneficiary billed on the claim (A line should be drawn
through any other beneficiaries listed)
• Claim Line Details-Draw a line through line items that have already been paid by Medicaid
Medicare EOMB Tips
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Top Denials
Denial Code Description Resolution
0104 Exact Duplicate ClaimPaid claim already on file. If applicable, the claim will need to
be voided and resubmitted.
0377This HCPC code must be billed with an
NDC
Check the drug code billed and ensure that there
is a rebatable NDC entered on the claim.
0610 EOMB requires review or is missing or invalidThe EOMB should be attached with the claim and have all
claim data.
0630Exact Duplicate Claim – Electronic
Crossover vs. Electronic Crossover
Paid claim already on file. If applicable, the claim
will need to be voided and resubmitted.
0750TPL – Beneficiary has primary insurance coverage – Resubmit
with TPL EOMB
Verify Primary Insurance coverage. Resubmit with primary
EOMB.
3259 Exceeds Timely FilingClaims must be submitted within 180 days from the
Medicare paid date.
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Tertiary Claims should be sent to:
Conduent State Healthcare, LLC
Attn: Rochelle McKinney
P.O. Box 23076
Jackson, MS 39225-3076
Include the claim and both EOMBs
from the primary payers.
Tertiary Claims
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What do I do if my crossover claim does not
crossover from Medicare?
The charges should be submitted to Medicaid
via hardcopy claim or through the Web Portal
along with a copy of the Medicare EOMB.
Can I correct a crossover claim online?
No. The claim should be voided and a new
claim along with the Medicare EOMB should be
submitted to Medicaid for consideration.
Helpful Hints
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If Medicare does not pay the claim but it should have, can I send it to Medicaid to pay?
If Medicare does not pay for a service and they should have, the claim cannot be submitted to
Medicaid without the Medicare EOMB.
Who is considered a dual eligible beneficiary and what part of those claims can I bill to
the patient?
Dually eligible beneficiaries are those eligible for both Medicare and Medicaid. Dual eligible
beneficiaries cannot be billed the difference between what the provider charges and the sum of
the Medicare and Medicaid payment.
Helpful Hints
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Is it a regular Medicaid claim if the service is not covered by Medicare but is covered by
Medicaid?
Yes, if Medicare denies a claim and the procedure code is covered by MS Medicaid, a Medicare
denial is considered to be a Medicaid primary claim.
Is (non-emergency) transportation available for dual eligible beneficiaries?
Claims may be filed for non-emergency transportation for dual eligible beneficiaries for services
not covered by Medicare if the reason for the Medicare denial is other than medical necessity.
What are the timely filing guidelines for crossover claims?
180 days from the Medicare paid date is the timely filing limitation for crossover claims.
Helpful Hints
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Are Part C claims crossed over from
Medicare?
Part C (Medicare Advantage) claims can only
be submitted via paper on the appropriate claim
form along with the Medicare Advantage
EOMB.
Helpful Hints
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1. Do not staple your claims together. Providers can simply place their
attachments behind the associated claims and place them in an
envelope.
2. Sign the claim in ink. The vast majority of the claims are Returned to
the Provider (RTP) because they are not properly signed.
3. Submit requests for Medicaid payment on Crossover form. Providers
should send claims with Medicare Explanation of Benefits (EOB)
showing that payment has been received from Medicare.
4. List the Third Party Liability (TPL) payment in the appropriate field.
For all claims submitted with TPL payments, the payment must be
shown in the prior payments (UB-04) field and the amount paid in
the (CMS-1500) field on the claim.
5. Do not send a stack of claims and one copy of the attachment that
goes with each claim. If there is an attachment that is critical to the
processing of the claim, copy the attachment for each claim and place
it with the associated claim before submitting those claims for
processing.
6. Submit standard 8 x 11 attachments. Strips, cutouts and the like are
not acceptable.
7. Put the bill date on each claim.
8. Place bill types on UB-04s and Crossover Part A forms.
9. Mail or electronically submit your claims. WE DO NOT ACCEPT
FAXED CLAIMS.
Dos and Don’ts
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