If a claim is
submitted to Medicare and 3 lines pay and 2 deny--will the two denied lines
crossover on that claim?
If a provider bills multiple lines to Medicare and Medicare pays one or
more lines but denies the others, the paid line(s) (as long as there are PRs)
will be crossed over to Medicaid and the provider must resubmit the crossover
payment as an adjustment to Medicaid to add the additional lines.
What if the deductible causes the claim to be zero paid by Medicare?
The claim will still be crossed over and the deductible will be paid by
Medicaid.
Are Medicare Part C or Part D claims part of the crossover
process?
No, Part C and Part D claims will not be part of the crossover process.
What will happen if I bill Medicare with a different NPI than I use to
bill Medicaid?
The NPI that is used on your Medicare claim must be enrolled with NY Medicaid.
Your crossover claims will not be processed if the NPI on your Medicare
claim is not enrolled with NY Medicaid. In this case, Medicaid will reject the
cross over claim back to Medicare and Medicare will send a notification letter
of the rejection to the provider
How do I enroll my NPI with NY Medicaid to take advantage of payments of
crossover deductibles and coinsurance?
Will I be able to submit adjustments and voids to crossover
claims?
You will be able to submit adjustments directly to Medicaid for crossover
claims. The adjustments will be submitted the same as any other
adjustment. Voids must be submitted to Medicare. Medicare will void the
claim and crossover over the voided transaction to Medicaid.
Will the Medicaid remittance distinguish between a void submitted from
Medicare as a cross over and a provider submitted void directly to
Medicaid?
There is no indication on the Medicaid remittance that the void was submitted
by Medicare or the provider.
What if I submit a claim directly to Medicaid for a patient who also
has Medicare?
If the crossover claim from Medicare is processed first, the provider submitted
claim will be denied as a duplicate claim. If the provider submitted claim is
processed prior to the Medicare crossover claim, the provider submitted claim
will be paid as it is today if zero fill indicator is included on the claim.
When the crossover claim is received it will also be paid. The eMedNY
system will then automatically void the provider submitted claim.
I submit Hospital Inpatient claims and many patients have Part B coverage
only (No Part A). Will the Part B coverage during an Inpatient stay be
part of the crossover?
Part B only claims are excluded from the crossover process and should be
submitted to Medicaid as they are today.
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