shahdb0323 wrote on Monday, August 19, 2013:
Hi there,
Is there a way to submit claim to primary and having the secondary insurance on the claim as well? Medicare will send the secondary claims automatically if the secondary insurance information is on the claim. As of now, we have to submit to primary and once the payments are received than we submit the secondary. It is lots of work.
Thanks
Shah
cmswest wrote on Monday, August 19, 2013:
Medicare crosses over most claims automatically and you can see this on the remittance. Are you sure you’re not duplicating the effort that has already been made? Can you pull a recent remit and check near the bottom where the cob info is usually posted?
shahdb0323 wrote on Monday, August 19, 2013:
That is exactly what I want to do. In order for medicare to cross over the claim to secondary, we have to have the secondary information on the claim. But I can’t find a way to do that. Openemr dose the primary first. The secondary claim dose not show on the claim sent to medicare. Am i doing something wrong.
fsgl wrote on Tuesday, August 20, 2013:
The way Medicare crossovers are done in our state is not through claim submission. The patient has to call the Medigap carrier and requested a Medicare crossover (claim forward). Medigap carriers will not accept the request from our office. Once the crossover has been set up, it is applied to claims from all offices. AARP and Medicaid have automatic setups for Medicare crossovers, therefore a patient does not have to call them.
Since the transition from the 4010 format to 5010, the claim forwarding has been flawed. Some claims are forwarded to the secondary and some not. Even if there is a note “Claim Information Forwarded To: (name of secondary)” for each claim, it may not be the case, therefore the secondary claim must be submitted.
Speak to your local Medicare carrier and ask how to setup crossovers. Our local Medicare carrier has a database of secondary insurers for beneficiaries. They know where to forward the claim. That is not the problem. The problem is initiation, if your state has the same setup protocol.
shahdb0323 wrote on Tuesday, August 20, 2013:
In CA the crossover is done automatically. We have been doing that using OfficeAlly and it has been working just fine. The secondary information can be entered on the claim that goes to Medicare and Medicare sends it to secondary. However, we can’t put the secondary information on the claim when sending it to medicare when creating X12 using the “fee-sheet” and “billing” in Openemr. I don’t know if I am doing something wrong. Do I need to do some setting? Has Openemr the function to enter secondary information on the claim (BOX 9-a-b-d) while sending the claim to primary (Medicare)?
Thank you for your reply
shahdb0323 wrote on Tuesday, August 20, 2013:
In CA the crossover is done automatically. We have been doing that using OfficeAlly and it has been working just fine. The secondary information can be entered on the claim that goes to Medicare and Medicare sends it to secondary. However, we can’t put the secondary information on the claim when sending it to medicare when creating X12 using the “fee-sheet” and “billing” in Openemr. I don’t know if I am doing something wrong. Do I need to do some setting? Has Openemr the function to enter secondary information on the claim (BOX 9-a-b-d) while sending the claim to primary (Medicare)?
Thank you for your reply
fsgl wrote on Tuesday, August 20, 2013:
Does your Medicare EOB’s have notes about claim forwarding for each patient?
It is not necessary to put anything in Box 9 for Medicare claims. Medicare knows who is the secondary without being told. Box 9 gets populated with Medicare information when submitting the secondary claim.
What are you doing differently now from the time you had no problems with Medicare crossovers?
cmswest wrote on Tuesday, August 20, 2013:
there’s always some flakiness with the coordination of benefits process
to be clear, there is no point in putting the secondary information on Medicare claims as CMS will only forward the claim if they have the info in their cob database
maybe someone could look at the logic for not producing a claim when the medicare eob says claim has been forwarded to secondary?
then in 60 days if the claim is still outstanding you could generate a secondary claim
shahdb0323 wrote on Wednesday, August 21, 2013:
Thank you for your reply.
I have been trying for the past two days to get an answer from Medicare in regards to how to set up the crossover. They told me to contact Coordination of Benefit department to set that up. COB tells me to contact the secondary insurance to set that up. The secondary tells me to contact Medicare.
Till now we have been using OfficeAlly directly to submit our claims. Our billing department send the claim directly from OfficeAlly and they have been entering the secondary info on the claims. We have never had any issue with getting payment from the secondary. Interestingly, the crossover is working fine even though we have never called medicare to set that up. But soon we will start using Openemr and the X12 for our billing. And since we can’t enter the secondary info on the claim using openemr, that mad me think that how will medicare crossover the claims.
Any thoughts? Thanks
fsgl wrote on Wednesday, August 21, 2013:
Hi Shah,
If your Medicare EOB’s indicate that all the claims have been forwarded to the secondary insurers, then don’t worry about it. What that tells me is that enough of your colleagues got the crossovers set up already, so you don’t have to bother with it.
Your Medicare Coordination of Benefits department is right, crossover is set up through the secondary, not via Medicare. It does not make sense, but that is how it is done.
Your billing staff’s completing Box 9 did nothing to establish the crossovers. Unfortunately it was a waste of their time. Send the 5010 x12 837P files (electronic claims from physicians) the way OpenEMR produces them and they will be fine. You may find that all this fretting was not necessary. You can always post more questions, if you encounter further difficulties.
Electronic claims from one company are usually paid in 2 weeks. If you don’t hear from the secondary carrier and the secondary’s Claim Status (from their website or phone system) says no claim found, then send them the x12 837P.