MEDICARE–MEDICAID CROSSOVER CLAIMS - FAQ

WHAT CLAIMS WILL CROSS OVER

A.Q1. Will all Medicare claims be crossed over to Michigan Medicaid?
A.A1: No.

A.Q2: Which Medicare claims will be crossed over to Michigan Medicaid?
A.A2: Michigan Medicaid is initially accepting only Medicare Part B professional claims from Wisconsin Physician Service (WPS).

A.Q3: Are there any claims excluded from the crossover process between WPS and Michigan Medicaid?
A.A3: Yes. The following types of claims will be excluded (not sent to Michigan Medicaid from WPS) from the crossover process:
• Totally denied claims;
• Claims denied as duplicates or for missing information;
• Adjustment claims (referred to as “replacement or void/cancel claims”);
• Claims reimbursed at 100 percent from WPS;
• Claims for dates of services outside the beneficiary’s Medicaid eligibility begin and end dates.

A.Q4: Will non-physician practitioner (e.g., PA, nurse practitioner, nurse mid-wife, psychologist, social worker, etc.) claims be crossed over to Michigan Medicaid?
A.A4: Yes. If the practitioner is directly enrolled in Michigan Medicaid, submit that Medicaid provider ID on the claim to WPS. Otherwise, the supervising physician/medical clinic Medicaid provider ID must be reported. (See C.Q1 & C.A1 for more information) WPS will pass this information on to Michigan Medicaid and it will be the basis of identifying the provider for purposes of Michigan Medicaid claims processing.

A.Q5: Which claims will NOT be crossed over to Michigan Medicaid?
A.A5: Claims processed by any Part B carrier other than WPS, a DMERC carrier, or any Part A claim will not be crossed over to Michigan Medicaid at this time. These claims must continue to be sent directly to Michigan Medicaid.

A.Q6: Will DMERC and Part A claims be crossed over?
A.A6: Not at this time; providers will be notified when this will occur.

A.Q7: Will hospital inpatient or outpatient Part B claims be crossed over to Michigan Medicaid? (New 10-04)
A.A7: No. Michigan Medicaid is initially accepting only Medicare Part B professional claims from WPS.

A.Q8: Will a HCFA 1500 paper claim sent to WPS be crossed over?
A.A8: HCFA 1500 paper claims sent to WPS will be sent to Michigan Medicaid in the HIPAA mandated 837 4010A1 format. There is no way to report the Medicaid provider ID on a paper claim submitted to WPS. Michigan Medicaid cannot process a crossover claim without the Medicaid provider ID. If you submit a paper claim to WPS, you will have to directly submit a claim to Michigan Medicaid after receiving the remittance advice from WPS. (Rev. 10-04)

A.Q9: Will a claim for a recipient who has Medicare, other insurance, and Medicaid be crossed over to all payers?
A.A9: No. Claims that include a secondary payer other than Michigan Medicaid may be crossed over to the secondary payer, but not to Michigan Medicaid. Once a remittance advice or explanation of benefits (EOB) is received from the secondary payer, the claim can be submitted directly to Michigan Medicaid, with the updated Medicare and other insurer payment and/or adjudication information.

A.Q10: Will claims where Medicare is the secondary payer and Michigan Medicaid is the tertiary payer be crossed over?
A.A10: Yes. If Michigan Medicaid is identified as the only other payer following Medicare, the Part B claims should be crossed over from WPS.

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