Question

Discuss the procedures for filing Medicare-Medicaid crossover claims under Medicaid.

Answer 1

When Medicaid providers submit claims to
Medicare for Medicare/Medicaid beneficiaries,
Medicare will pay the claim, apply a
deductible/coinsurance or co-pay amount and then
automatically forward the claim to Medicaid.
Providers will NO longer need to bill Medicaid
separately for the Medicare deductible, coinsurance.

New York State Medicaid will receive Medicare
crossover claims from the Coordination of Benefits
Contractor (COBC), Group Health Inc. (GHI). The
various Medicare payers across the State will all
transmit paid claims for Medicare/Medicaid
beneficiaries to GHI. GHI will transmit the claims. Medicare remittance will have an indicator
that will show the claim was an automatic cross
over to Medicaid. When the indicator appears on
the Medicare remittance you will not bill Medicaid for those clients. he crossover will occur at the same time the
Medicare EOMB is released. Therefore the
provider will see the Medicare EOMB before they
see the Medicaid remittance or the crossover
payments from eMedNY..