Medicare Compliance & Reimbursement

Unsuccessful crossover claims will prompt auto notice.

Starting July 5, Medicare contractors will issue special automated notices to physicians, providers and suppliers when claims do not cross over to supplemental payers or insurers as expected.

The Centers for Medicare and Medicaid Services says through the Coordination of Benefits Agreement process, claims are usually sent to supplemental payers or insurers after Medicare has made its payment decision. However, HIPAA-related claims errors may prevent Medicare from crossing the claim as normal, a recent Medlearn Matters article (MM3709) explained.

In those situations, contractors will pass the responsibility back to the provider. Expect a detailed error report notice containing specific claim information, along with the following message: "The above claim(s) was/were not crossed over to the patient's supplemental insurer due to claim data errors."