1. What is meant by the crossover payment?
When Medicaid providers submit claims to Medicare for Medicare/Medicaid
beneficiaries, Medicare will pay the claim, apply a deductible/coinsurance or
co-pay amount and then automatically forward the claim to Medicaid. Providers
will NO longer need to bill Medicaid separately for the Medicare deductible,
coinsurance or co-pay amounts.
2. How will the crossover process work?
New York State Medicaid will receive Medicare crossover claims from the
Coordination of Benefits Contractor (COBC), Group Health Inc. (GHI). The
various Medicare payers across the State will all transmit paid claims for
Medicare/Medicaid beneficiaries to GHI. GHI will transmit the claims to eMedNY.
How will I know if my Medicare claims were crossed over to Medicaid?
Your Medicare remittance will have an indicator that will show the claim was an
automatic cross over to Medicaid. When the indicator appears on the Medicare
remittance you will not bill Medicaid for those clients
Will Medicare release the Medicare EOMB to the providers before the claim is
crossed over to eMedNY?
What will be the indicator on the Medicare paper remittance?
The Medicare Remittance will include a Remittance Remark Code of MA18
indicating the claim has been forwarded to a supplemental payer and will name
NY Medicaid as that payer
What is the loop and segment for the Medicare indicator on the electronic
835 remittance?
There will be no changes to the content of the Medicaid paper remittance or the
Medicaid electronic 835 remittance.
I get my Will the crossover affect how electronic 835
remittances?
Your Medicaid 835 remittance will be generated to that Electronic Transmitter
ID Number (ETIN) that is designated by you as your default ETIN. If no
ETIN has been designated as a default ETIN then the remittance will be produced
as a paper remittance.
How can I designate an ETIN as my default ETIN?
To indicate an ETIN as a default ETIN, the provider must complete a Default
ETIN Selection Form available on emedny.org.
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