Thursday, April 28, 2016

Submitting secondary cliams with Medicare EOB


MEDICARE/MEDICAL ASSISTANCE CROSSOVER CLAIMS

When a Medical Assistance provider bills Medicare Part B for services rendered to a MA recipient, and the provider accepts assignment on the claim (Block #27), Medical Assistance pays the provider the Medicare coinsurance and/or deductible amount(s) in full less any other third party payments (i.e., Medigap). In order for claims to be accurately cross-referenced to your Medicaid provider number, be sure to advise the Claims Processing/Medicare Crossover Unit of your Medicare provider number and NPI number so that all provider numbers can be properly linked in the Medicaid system. Requests to add, change, or delete information on the Medicare crossover file must be sent in writing to the address below Attention: Jack Collins or call 410-767-5559.


PROCEDURES FOR SUBMITTING HARDCOPY MEDICARE CLAIMS

Billing a CMS-1500 with a Medicare EOMB:

On the Medicare EOMB, each individual claim is generally designated by two horizontal lines. Therefore, you should complete one CMS-1500 form per set of horizontal lines.

• When billing Medical Assistance, the information on the CMS-1500 must be identical to the information that is between the two horizontal lines on the Medicare EOMB.

o Dates of service must match

o Procedure codes must match

o Amount(s) on line #24F of the CMS-1500 must match the “amount billed” on the EOMB.

• When submitting your Medicare claims for payment, the writing should be legible. In addition, when attaching a copy of the Medicare EOMB make sure it is clear and that the entire EOMB, including the information on the top and the glossary is included on the copy. In order for MA to pay for co-insurance and deductibles, the CMS-1500 and the Medicare EOMB must be submitted. Claims
should be sent to the original claims address:

                                               Maryland Medical Assistance
                                                   Claims Processing
                                                     P.O. Box 1935
                                                 Baltimore, MD 21203

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