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December 2016 Texas Medicaid Provider Procedures Manual

Section 6: Claims Filing : 6.12 Filing Medicare Primary Claims : 6.12.1 Electronic Crossover Claims

6.12.1
Medicare primary claims filed to MACs may be transferred electronically to TMHP through a COBC for claims that are processed as assigned. Providers should contact their MAC for more information.
This electronic crossover process allows providers to receive disposition from both carriers while only filing the claim once. Providers must allow 60 days from the date of Medicare’s disposition for a claim to appear on the Medicaid R&S Report.
If all services on the claim are denied by Medicare, the claim is not automatically transferred to TMHP by the MAC through the COBC. Providers must submit the denied crossover claims to TMHP on paper.
Claims that are submitted to Medicare must include the facility’s NPI. Medicare crossover claims must comply with the Medicaid requirement to include a facility NPI. If a Medicare crossover claim includes a service for which Medicaid requires a facility NPI but the claim does not include the facility’s NPI number, the claim will be denied by Texas Medicaid.
Important:
TMHP accepts only electronic crossover claims that are automatically transferred to TMHP by the MAC through the COBC. TMHP accepts only paper crossover claims from providers and other entities. TMHP does not accept electronic crossover new day claims or appeals from providers and other entities. TMHP accepts only paper appeals.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2014 American Medical Association. All rights reserved.