payment not received for cross over claims

D.Q1: How will I know WPS crossed over my claim?
D.A1: Your Medicare remittance advice will include remark code MA07 (“The claim information has also been forwarded to Medicaid for review”) for the claims that have been crossed over.

D.Q2: How will I know Michigan Medicaid’s payment decision? (New 10-04)
D.A2: Crossover claims will appear on your Michigan Medicaid remittance advice, just like claims sent directly to Michigan Medicaid.

D.Q3: What happens if the Medicare remittance advice indicates that a claim was crossed over but a response or payment from Michigan Medicaid is missing?
D.A3: If providers receive payment from Medicare and the WPS remittance advice indicates the claim was crossed over to Michigan Medicaid but you do not see the claim appearing on the Medicaid RA within 30 days, then the claim should be submitted directly to Michigan Medicaid with the updated Medicare payment and/or adjudication information.

D.Q4: What should I do about crossover claims rejected or denied by Michigan Medicaid?
D.A4: If it appears the claim has been inappropriately rejected or denied by Michigan Medicaid, contact the MDCH Provider Support line at 1-800-292-2550

D.Q5: How does a previously crossed over claim that needs to be adjusted (replacement or void/cancel) get submitted to Medicare and Michigan Medicaid? (New 10-04)
D.A5: Submit the adjustment (replacement or void/cancel) to Medicare first. Adjustments (replacements or void/cancels) are excluded from the crossover process. When the remittance advice arrives from Medicare, submit the claim adjustment (replacement or void/cancel) directly to Michigan Medicaid with the updated Medicare payment and/or adjudication information.

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