KMAP BULLETIN: Medicare Crossover Claim Processing Changes

Date: 08/09/17

KMAP GENERAL BULLETIN 17189

To comply with the Centers for Medicare & Medicaid Services (CMS) Managed Care regulations at Federal Register § 438.3(t), States that use the automated crossover process must require managed care organizations (MCOs) to enter into a Coordination of Benefits Agreement (COBA) with Medicare and be able to accept and process automated crossover claims. The COBA automatic crossover process allows CMS and the State to use a standardized contract that outlines criteria for the submission of eligibility information and Medicare adjudicated claim data allowing for the coordination of benefits in claims processing.

CMS uses a single-source national crossover contractor, the Benefits Coordination & Recovery Center (BCRC), to handle coordination of crossover data. This entity is also referred to as the Coordination of Benefits Contractor (COBC).

Effective on and after January 1, 2018, all crossover claim files will be sent from the COBC directly to the applicable MCO. The routing of the affected claims will be determined by the member’s assignment dates with the MCO or KMAP. Providers will not need to change the way crossover claims are billed. COBC will route the claim to the appropriate payer.

In order to facilitate a seamless transition, KMAP is requesting that providers submit a request to add or update their current Medicare National Provider Identifier (NPI) numbers with KMAP. This will allow claims to process correctly when automatically crossing over from Medicare. To submit Medicare NPI information, the provider can contact KMAP Provider Enrollment by email at LOC-KSXIX-Provider-Enrollment@groups.ext.hpe.com. The email should include the KMAP provider identification (ID) number, provider telephone number, Medicare NPI, and effective date of the NPI. Providers can contact KMAP at 1-800-933-6593, option 3, with any additional questions.

Providers should not send the Provider Transaction Access Number (PTAN) in place of the Medicare NPI number. This number is issued to Medicare providers upon enrollment with Medicare to use when accessing online Medicare tools. This does not replace the Medicare NPI that is used to bill the Medicare program. The PTAN will not allow claims from Medicare to be processed when automatically crossed over.

Reference General Bulletin 17011 and General Bulletin 17037 on the Bulletins page of the KMAP website.