KMAP BULLETIN: Medicare Crossover Claims Provider Opt-Out Changes
Date: 11/28/17
KMAP GENERAL BULLETIN 17261
As outlined in the following bulletins, providers were asked to add or update their current Medicare National Provider Identifier (NPI) with the Kansas Medical Assistance Program (KMAP) so claims automatically crossing over to KMAP from the Centers for Medicare & Medicaid Services (CMS) will process correctly.
- General Bulletin 17011, Medicare Crossover Claims Processing Changes
- General Bulletin 17037, Additional Information about Medicare Crossover Claims Processing Changes
- General Bulletin 17189, Medicare Crossover Claim Processing Changes
Currently, providers may choose to “opt out” of the Automatic Crossover Process by not providing the Medicare NPI to KMAP. When KMAP does not have the Medicare NPI on file with an effective date for processing automatic crossovers, the automatic crossover claims will be denied by KMAP and the provider will not receive a remittance advice.
Effective January 1, 2018, automatic crossover claims will be sent directly to and processed by the managed care organization (MCO) based on the member assignment. Sunflower will be unable to allow providers to opt out of the automatic crossover process. As a result, claims received by Sunflower from the Benefits Coordination & Recovery Center (BCRC) will process as paid or denied and the provider will receive a remittance advice.
By January 1, 2018, UnitedHealthcare (UHC) and Amerigroup will have an automated process similar to the one for KMAP in place to process the option the provider has chosen for automatic crossover claims.
Note: Effective January 1, 2018, the provider should continue to notify KMAP with their updates if they do not want claims to crossover.
Reference General Bulletin 17011, General Bulletin 17037, and General Bulletin 17189 on the Bulletins page of the KMAP website.