Will Medicare cross over claims with no patient responsibilities? Clinic pricing, how much payment for crossed over claims?

 How does the Medicare Crossover process affect my Medicaid billing? 
You will no longer need to submit claims directly to Medicaid for those Medicaid patients who have both Medicare (Parts A &/or B) and Medicaid.

Will Medicare Crossover process affect my Medicare billing? 

In most instances, there are no changes to how you bill Medicare however Institutional providers who submit with rate codes are encouraged to include the Medicaid rate code on their claim to Medicare if they submit on the 837I . (See the next FAQ on how to  bill with a rate code)

 I receive enhanced Clinic pricing on my claims, will that payment methodology continue? 
The enhanced pricing will continue only if the claim submitted to Medicare contains your Medicaid rate code. If the claim submitted to Medicare does not have your Medicaid rate code the crossover payment will be only the deductible, coinsurance or co-pay due.  Send your claim to Medicare with the Medicaid rate code in Loop 2300 in the HI Value Information segment in data element HI01.

(visit eMedNY.org for more information at www.emedny.org/hipaa/FAQs/Rate_Codes.html) Rate codes are sent to Medicaid as 4-digit (numeric) values. If submitting the rate code to Medicare, the following amount format should be used: (NN.NN). N=number and the decimal must be included.

If you do not send the Medicaid rate code on your claim to Medicare, you will need to resubmit an adjustment to Medicaid with the correct rate code on the claim in order to receive the enhanced Clinic payment.

 If I am submitting the rate code on my Medicare claim, is there a special format? 
Send your claim to Medicare with the Medicaid rate code in Loop 2300 in the HI Value Information segment in data element HI01.  The following amount format should be used: (NN.NN). N=number and the decimal must be included.

 What amount will Medicaid reimburse on the crossover claims? 
The amount paid by Medicaid will be the deductible/coinsurance or co-pay amounts as indicated on the crossover claim from Medicare.

Will Medicare cross over claims with no patient responsibilities? 

No, only claims with PRs will be part of the automatic crossover system.

 Will I still need to do Medicaid Eligibility verification for claims I send to Medicare?
Yes, providers will still need to verify Medicaid eligibility with eMedNY as you do today.  Send  your claim to Medicare, and your claim will be automatically crossed over to Medicaid if the client is eligible for Medicaid.

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