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?
Enrollments application can be found on this website under Provider Enrollment.
Questions about the enrollment process may be directed to the eMedNY Call
Center at 1-800-343-9000.
