Automatic Crossover for All Medicare Claims
All Blue Plans automatically cross over Medicare claims for services covered under Medigap and Medicare Supplemental products to secondary payers. These automatic submissions eliminate the need for your office or billing service to submit an additional claim to the secondary carrier.
How to submit Medicare primary/Blue Plan secondary claims?
- For members with Medicare primary coverage and Blue Plan secondary coverage, submit claims to your Medicare intermediary and/or Medicare carrier.
- When submitting the claim, it is essential that you enter the member’s Blue Plan name as the secondary carrier. This may be different from the local Blue Plan. Always check the member’s identification (ID) card.
- The alpha prefix is critical for confirming membership and coverage, and for facilitating prompt payment. Always include the alpha prefix as part of the member ID number in the first three positions.
When you receive the remittance advice from the Medicare intermediary, verify that the claim has been automatically forwarded (crossed over) to the Blue Plan.
If the remittance indicates that the claim was crossed over, Medicare has forwarded the claim on your behalf to the appropriate Blue Plan and the claim is in process.
There is no need to resubmit that claim to Highmark Blue Shield of Northeastern New York.
- If the remittance indicates that the claim was not crossed over, submit the claim to Blue Shield with the Medicare remittance advice.
- In some cases, the member identification card may contain a Coordination of Benefits Agreement (COBA) ID number.
If so, be certain to include that number on your claim.
- For claim status inquiries, log onto wnyhealthenet.org or call Blue Shield at 1-518-220-5700 or 1-800-459-7587.
When should I expect to receive payment?
The claims submitted to the Medicare intermediary will be crossed over to the Blue Plan only after they have been processed by the Medicare intermediary. This process may take up to 14 business days. This means that the Medicare intermediary will be releasing the claim to the Blue Plan for processing about the same time you receive the Medicare remittance advice. As a result, it may take an additional 14-30 business days for you to receive payment from the Blue Plan.
What should I do in the meantime?
If you submitted the claim to the Medicare intermediary/carrier, and haven’t received a response to your initial claim submission, do not submit another claim. Instead, always:
- Review the automated resubmission cycle on your claim system.
- Wait 30 days.
- Check claims status before resubmitting.
Please note: Sending another claim or having your billing agency resubmit claims automatically slows down the claim payment process and creates confusion for the member.