Name of Manual - Blue Cross and Blue Shield of Minnesota

Claims Filing
Medicare Crossover Blue Cross provides COBC a weekly eligibility file of all Blue
Cross members enrolled for coverage under the Medicare program.
When Medicare processes a claim, the Medicare patient’s HICN
will be compared to the HICNs on the eligibility file sent by us. If
found, the date of service on the Medicare claim will be compared
to the Blue Cross coverage effective and cancel dates. If the
claim’s date of service falls within those dates, the claim will be
crossed over to us electronically.
837I Crossover
Information
837P Crossover
Information
The current message indicating the claim was sent to Blue Cross
will continue to be displayed on the patient’s Medicare Summary
Notice (MSN) or on the Explanation of Medicare Benefits
(EOMB). Medicare will indicate on the provider’s Remittance
Advice (RA) if the claim was sent to the supplemental insurer. On
the Intermediary RA, claim status codes of 19, 20, or 21 indicate
that the claim was crossed over. If the HICN is not found on the
Blue Cross eligibility file, or if the date of service on the claim is
outside the given Blue Cross coverage effective and cancel dates,
the claim will not be forwarded to us electronically.
A note associated with the ANSI remark code indicates which
payer will receive the claim information. Providers will continue to
see MA18 and the name of the payer on the Medicare RA when
the payment information is forwarded to a single payer. However,
code N89 will be used when the payment information is forwarded
to multiple payers; only one of those payers will be named on the
RA even though the payment information is forwarded to multiple
payers.
Paper claims submitted to Blue Cross with the Medicare RA
attached and the N89 remark code stating the payment information
was forwarded to Blue Cross will be returned to the provider.
Adjusted Medicare B claims will not be crossed over to us.
If the claim is not forwarded, then:
The statement or code indicating the claim was forwarded to us
will not appear on the MSN, EOMB or RA.
The patient or provider must submit the electronic claim to us
populating Medicare’s payment information within the claim
record.
8-26 Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (05/10/12)