How does the
Medicare Crossover process affect my Medicaid billing?
You will no longer need to submit claims directly to Medicaid for those
Medicaid patients who have both Medicare (Parts A &/or B) and Medicaid.
Will Medicare Crossover process affect my Medicare billing?
In most instances, there are no changes to how you bill Medicare however
Institutional providers who submit with rate codes are encouraged to include
the Medicaid rate code on their claim to Medicare if they submit on the 837I .
(See the next FAQ on how to bill with a rate code)
I receive enhanced Clinic pricing on my claims, will that payment
methodology continue?
The enhanced pricing will continue only if the claim submitted to Medicare
contains your Medicaid rate code. If the claim submitted to Medicare does not
have your Medicaid rate code the crossover payment will be only the deductible,
coinsurance or co-pay due. Send your claim to Medicare with the Medicaid
rate code in Loop 2300 in the HI Value Information segment in data element
HI01.
(visit eMedNY.org for more information at www.emedny.org/hipaa/FAQs/Rate_Codes.html)
Rate codes are sent to Medicaid as 4-digit (numeric) values. If submitting the
rate code to Medicare, the following amount format should be used: (NN.NN).
N=number and the decimal must be included.
If you do not send the Medicaid rate code on your claim to Medicare, you will
need to resubmit an adjustment to Medicaid with the correct rate code on the
claim in order to receive the enhanced Clinic payment.
