02/13/2020

Auto Cross Claims for Medicare as Primary and Medicaid as Secondary

We have a general question about a patient who has Medicare and Medicaid. In the past, when the charges were applied to the Medicare Deductible, we had to manually complete a form and send it directly to Medicaid to pick up the Medicare deductible amount. It was never automatically sent by Medicare to Medicaid. Lately, we are noticing that on the Medicare Remittance Advice, code MA07 indicates that the charges have been sent to Medicaid. Is this something new? Are they really sending it directly or do we have to manually do this?

If a patient has a secondary insurance on file with Medicare, Medicare will autocross the part B coinsurance or deductible to that secondary. This would apply for Medicaid, Blue Cross, Emblem Health and many other common policies secondary to Medicare. A majority of the time, information crosses over from Medicare to the secondary with no issue. However, there may be occasions where you will have to follow up to make sure that patient responsibility from Medicare is processed correctly.

If you do not receive payment or correspondence from a secondary, follow up should be done to make sure that the claim did cross over from Medicare and no additional information is needed.  In addition patients may need to coordinate their benefits if secondary Insurance changes.