08/18/2020

Issue with Medicare Auto Crossing Claims

In the last week medicare auto-forwarded secondary to the wrong carrier for Emblem Health patients they were sent to BC/BS. When we check NGS Connex patient secondary comes up as NYSWGS. The patients have not changed from emblem health as far as they know. Does this have something to do with the new ID numbers for Emblem health? Please help we are not being paid for the secondary portion of the medicare claims. Is anyone else having this issue?

This has nothing to do with the new ID numbers that were assigned to Emblem Health patients- this was an update with Medicare that would need to be corrected. The problem is that instead of only routing Medicare part A claims to Blue Cross to cover outstanding patient responsibility for hospital claims, they are auto crossing medical claims that should be reimbursed by Emblem Health. NGS Medicare is aware of the issue, the only thing that can be done at this time is to mail secondary claims to Emblem Health for processing to ensure that secondary claims are processed within a timely manner.