How can we know Medicare crossed over the claims to Medicaid?

1.  What is meant by the crossover payment?

When Medicaid providers submit claims to Medicare for Medicare/Medicaid beneficiaries, Medicare will pay the claim, apply a deductible/coinsurance or co-pay amount and then automatically forward the claim to Medicaid. Providers will NO longer need to bill Medicaid separately for the Medicare deductible, coinsurance or co-pay amounts.

2.  How will the crossover process work? 

New York State Medicaid will receive Medicare crossover claims from the Coordination of Benefits Contractor (COBC), Group Health Inc. (GHI).  The various Medicare payers across the State will all transmit paid claims for Medicare/Medicaid beneficiaries to GHI. GHI will transmit the claims to eMedNY.

How will I know if my Medicare claims were crossed over to Medicaid? 

Your Medicare remittance will have an indicator that will show the claim was an automatic cross over to Medicaid. When the indicator appears on the Medicare remittance you will not bill Medicaid for those clients

Will Medicare release the Medicare EOMB to the providers before the claim is crossed over to eMedNY? 

The crossover will occur at the same time the Medicare EOMB is released.  Therefore the provider will see the Medicare EOMB before they see the Medicaid remittance or the crossover payments from eMedNY.

 What will be the indicator on the Medicare paper remittance? 

The Medicare Remittance will include a Remittance Remark Code of MA18 indicating the claim has been forwarded to a supplemental payer and will name NY Medicaid as that payer

What is the loop and segment for the Medicare indicator on the electronic 835 remittance? 

There will be no changes to the content of the Medicaid paper remittance or the Medicaid electronic 835 remittance.

I get my  Will the crossover affect how electronic 835 remittances? 
Your Medicaid 835 remittance will be generated to that Electronic Transmitter ID Number (ETIN) that is designated by you as your default ETIN.  If no ETIN has been designated as a default ETIN then the remittance will be produced as a paper remittance.

 How can I designate an ETIN as my default ETIN?
To indicate an ETIN as a default ETIN, the provider must complete a Default ETIN Selection Form available on emedny.org.




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