March 2025

Reminder: Follow guidelines established for processing Medicare primary claims

What you need to know

We’re reviewing the correct process for submitting Medicare supplemental claims that are eligible for crossover and claims for services that are statutorily excluded from Medicare coverage.
To prevent duplicate claims, heath care providers should wait to submit supplemental claims until after the minimum 30-day period has been met.
If the Medicare remittance indicates to the provider that the claim was a crossover claim to Blue Cross, the provider doesn’t need to submit a claim directly to us.

Medicare primary claims must be submitted to Medicare for processing. Medicare is then responsible for forwarding the claims to Blue Cross Blue Shield of Michigan through a crossover arrangement for secondary payment determinations.

Blue Cross requires, at minimum, a 30-day waiting period after the Medicare remittance date before we can accept and process a health care provider-submitted Medicare supplemental claim that is eligible for crossover.

Electronic professional and facility claims received before the 30-day waiting period will obtain the following Blue Cross front-end edit:

Professional — AS0246 Supplemental Claim Received Within 30 Days of Medicare Processing Date
Facility — AS0248 Supplemental Claim Received Within 30 Days of Medicare Processing Date

Check your response files (acknowledgments and reports) and payer (277CA) reports for front-end edits through Availity Essentials™, our provider portal. Edited claims can’t be resubmitted until 30 days after the Medicare remittance date has lapsed.

You should only bill Blue Cross directly before the 30-day remittance date for a patient with Medicare primary coverage when the service provided is statutorily excluded from Medicare coverage.

For statutorily excluded services, it’s important to note:

Providers who offer statutorily excluded services, or services not eligible for payment under Medicare, must indicate these services by using a GY modifier at the claim line level.
Submit statutorily excluded service lines on a separate claim. Don’t combine those lines with other services.
Providers will no longer have to first submit known statutorily excluded services to Medicare for consideration.

Availity^® is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to offer provider portal and electronic data interchange services.

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2024 American Medical Association. All rights reserved.