Reminder: Follow guidelines established for processing Medicare primary claims

Medicare primary claims must be submitted to Medicare for processing. Medicare is then responsible for forwarding the claims to Blue Cross Blue Shield of Michigan via a crossover arrangement for secondary payment determinations.

Blue Cross requires, at minimum, a 30-day waiting period after the Medicare remittance date before we can accept and process a provider-submitted Medicare supplemental claim that is eligible for crossover.

Professional and facility electronic provider-submitted claims received before the 30-day waiting period will obtain the following Blue Cross front-end edit:

• Professional = AS0246 Supplemental Claim Received Within 30 Days of Medicare Processing Date.
• Facility = AS0248 Supplemental Claim Received Within 30 Days of Medicare Processing Date.

In our provider portal, Availity, check your response files (acknowledgments and reports) and payer (277CA) reports for front-end edits. Edited claims can’t be resubmitted until 30 days after the Medicare remittance date has lapsed.

You should only bill Blue Cross directly before the 30-day remittance date for a patient with Medicare primary coverage when the service provided is statutorily excluded from Medicare coverage.

For statutorily excluded services, it’s important to note:

• Providers who offer statutorily excluded services must indicate these services by using a GY modifier at the claim line level.
• Submit statutorily excluded service lines on a separate claim. Don’t combine those lines with other services.
• Providers will no longer have to first submit known statutorily excluded services to Medicare for consideration.

Availity^® is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to offer provider portal and electronic data interchange services.