Reminder: Follow guidelines established for processing Medicare primary claims

Keep in mind that Blue Cross Blue Shield of Michigan changed how it processes Medicare primary claims, effective Oct. 13, 2013. The change aligns with the Blue Cross and Blue Shield Association’s policies.

The Blue Cross and Blue Shield Association requires a minimum 30-day waiting period after the Medicare remittance date before a Blue plan can accept or process provider-submitted supplemental claims that involve Medicare crossover.

Medicare primary claims are submitted to Medicare for processing and then forwarded to a secondary insurance carrier via a crossover arrangement for additional payment determinations.

Providers can identify Medicare crossover claims that have been sent to Blue Cross by looking for remittance advice remark codes MA18 and N89.

Providers can identify Medicare crossover claims that have been sent to BCBSM by remark codes MA18 and N89 returned on the Medicare Remittance Advice and electronic remittance (835).

Electronic claims submitted within the 30days will receive the following BCBSM EDI front end edits:

• P951  A3  516        SUPPLEMENTAL CLM RECD WITHIN 30 DAYS OF MEDICARE PROC DATE
• F716  A3  516        SUPPLEMENTAL CLM RECD WITHIN 30 DAYS OF MEDICARE PROC DATE

Edits will be returned in our 277CAP transactions and R277CAH and R277CAI edit reports. Edited claims cannot be resubmitted until the 30 days have lapsed.

If you have questions regarding the edits, contact the eBIG/EDI Business help desk at 1-800-542-0945.

For more information about this process, please see the September 2013 Record.