Medicare crossovers are electronically filed claims that Medicare forwards or “crosses over” to BCBSLA automatically when the BC member is in the Medicare eligibility file. This process includes claims where Medicare is primary and BCBSLA is secondary. In addition to BCBSLA receiving claims for providers within the state of Louisiana, effective January 1, 2008, all Blue Cross and Blue Shield plans established a standardized Medicare Crossover Agreement with Centers for Medicare & Medicaid Services. This standard agreement will require that crossover claims be sent directly from the Medicare Crossover Carrier, Group Health Inc. (GHI), to the member's BCBS Plan. For instance, we now receive claims for Louisiana members via the crossover process from out-of-state providers (Texas, Arkansas, etc.).
Claim sent from Medicare to a Blue Cross Plan
When a claim is crossed over from Medicare, you will receive a message beneath the patients claim information on the Medicare remittance advice. If the remittance does not contain a message similar to the examples below, the claim was not forwarded electronically for processing. This claim must be filed with the Plan listed on the members ID card. For BCBSLA claims that did not crossover, we will need a paper claim along with a copy of the Medicare Remittance Advice which indicates the Medicare payments for the claim.
The above message indicates that the claim was forwarded electronically from Medicare to Blue Cross and Blue Shield of Louisiana for processing.
The above message indicates that the claim was forwarded electronically from Medicare to Blue Cross and Blue Shield of Texas for processing. When a claim is forwarded to an out-of-state Blue Plan, the state the claim was sent to will be listed in the message.
