Medicare Claims Crossover to Supplemental Payer Problem

The Centers for Medicare & Medicaid Services (CMS) has identified a problem where claims were not automatically crossing over to supplemental payers even though the provider remittance advice indicated otherwise. This problem began January 5, 2010. Part A institutional claims and Part B professional claims, with the exception of supplier claims processed by Durable Medical Equipment Medicare Administrative Contractors (DME MACs), were impacted by this problem. Claims processed by DME MACs were not impacted.

Part A Institutional Claims

No action is required by Part A institutional providers. As of February 2, 2010, CMS successfully implemented a systems fix to ensure that all Part A institutional claims are now crossing over to supplemental payers as indicated on the remittance advice received by providers. As part of the fix, CMS' Medicare contractors were able to identify claims processed between January 5 and February 1, 2010, where the provider remittance advice indicated that the affected claims were crossed over to various supplemental payers but were not. On February 2, 2010, the affected Medicare contractors began to send the affected claims to the Coordination of Benefits Contractor (COBC) to be crossed over to supplemental payers. This effort is now largely completed. Please allow until March 1, 2010, for supplemental payers to receive and process these claims before attempting to balance bill them for any remaining balances after Medicare.

The CMS has already notified supplemental payers of these issues. We regret any inconvenience you may experience related to this Medicare claim supplemental payer crossover problem.

CMS JSM-10139
February 16, 2010

Page last updated: February 17, 2010

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