If a provider bills multiple lines to Medicare and Medicare pays one or more lines but denies the others, the paid line(s) (as long as there are PRs) will be crossed over to Medicaid and the provider must resubmit the crossover payment as an adjustment to Medicaid to add the additional lines.
What if the deductible causes the claim to be zero paid by Medicare?
The claim will still be crossed over and the deductible will be paid by Medicaid.
Are Medicare Part C or Part D claims part of the crossover process?
No, Part C and Part D claims will not be part of the crossover process.
What will happen if I bill Medicare with a different NPI than I use to bill Medicaid?
The NPI that is used on your Medicare claim must be enrolled with NY Medicaid. Your crossover claims will not be processed if the NPI on your Medicare claim is not enrolled with NY Medicaid. In this case, Medicaid will reject the cross over claim back to Medicare and Medicare will send a notification letter of the rejection to the provider
How do I enroll my NPI with NY Medicaid to take advantage of payments of crossover deductibles and coinsurance?
Enrollments application can be found on this website under Provider Enrollment. Questions about the enrollment process may be directed to the eMedNY Call Center at 1-800-343-9000.
Will I be able to submit adjustments and voids to crossover claims?
You will be able to submit adjustments directly to Medicaid for crossover claims. The adjustments will be submitted the same as any other adjustment. Voids must be submitted to Medicare. Medicare will void the claim and crossover over the voided transaction to Medicaid.
Will the Medicaid remittance distinguish between a void submitted from Medicare as a cross over and a provider submitted void directly to Medicaid?
There is no indication on the Medicaid remittance that the void was submitted by Medicare or the provider.
What if I submit a claim directly to Medicaid for a patient who also has Medicare?
If the crossover claim from Medicare is processed first, the provider submitted claim will be denied as a duplicate claim. If the provider submitted claim is processed prior to the Medicare crossover claim, the provider submitted claim will be paid as it is today if zero fill indicator is included on the claim. When the crossover claim is received it will also be paid. The eMedNY system will then automatically void the provider submitted claim.
I submit Hospital Inpatient claims and many patients have Part B coverage only (No Part A). Will the Part B coverage during an Inpatient stay be part of the crossover?
Part B only claims are excluded from the crossover process and should be submitted to Medicaid as they are today.