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Elizabeth M. Whitehorn, Director

MEDI Affecting Medicare Crossovers

Problem:

A change made to the MEDI system on 6/3/14 inadvertently affected the submission of Medicare crossover claims. The Medicare and TPL coinsurance and deductible amounts entered were not applied to the claim. This caused the system to use the Medicare allowed amount as the Medicare Paid Amount causing the claim to pay at $0.00 or reject with an R36, Part B Service, Bill Medicare.

Providers Impacted:

Non Institutional Providers and Pharmacy Providers using the MEDI system’s Medicare Crossover form.

Procedure Codes Impacted:

All procedure codes billed.

Problem Begin Date:

June 3, 2014

Problem Fix Date:

Claims submitted through MEDI after June 26, 2014, 4:07 PM.

Resolution for Impacted Claims:

If the claim was paid, it must be voided. The department encourages providers to utilize the 837P replacement claim process (bill type ‘7’) through MEDI or through a vendor. This is a one-step process for voiding a previously paid claim and replacing the original claim. If a replacement claim is submitted within 12 months from the original paid voucher date, a timely filing override will not be required.

Providers can also complete a paper HFS Form 2292, Adjustment NIPS, to void a paid service or claim. After the void has been processed, an HFS 3797, Medicare Crossover Form, or an electronic claim can be billed through MEDI or a vendor.