Bulletin: September 24, 2007

Medigap Crossover Claims

By: Technical Writer, Quadax, Inc.

Effective October 1, 2007, CMS will transfer the mandatory Medigap insurance claim-based crossover process from its Medicare contractors to the national Coordination of Benefits Contractor (COBC). Because of this change, the COBC is issuing new Medigap identifiers for insurance companies offering Medigap policies, allowing Medicare to forward claims directly to the secondary insurance. This new Medigap claim-based ID will replace the existing Medigap Number. Providers must include the new Medigap identifier on their incoming Medicare claims by October 1st to trigger crossovers to Medigap insurers.

Updating Medigap Numbers in HARP

CMS has a list of the new Medigap claim-based IDs at http://www.cms.hhs.gov/COBAgreement/Downloads/Medigap Claim-based COBA IDs for Billing Purpose.pdf. The list includes only those insurers who have signed a national crossover agreement with the COBC and have tested the crossover process. Other insurers will be added when they fulfill these requirements.

Manager and Partner clients. Quadax is updating the virtual insurance Medigap Numbers for all accounts on our system. HARP will pull this number for the majority of claims. However, if any insurance has a Medigap Number specified at the client level, it will override the updated virtual number. For claims to these insurers, the Electronic Remittance Advice (ERA) will show the following MA19 error:

Information was not sent to the Medigap insurer due to incorrect/invalid information you submitted concerning the insurer. Please verify your information and submit your secondary claim directly to that insurer.

See CR#5601 for details. If you receive this error, please contact your Quadax Service Consultant so the Medigap number can be corrected in HARP.

Standalone clients. Standalone clients should replace each insurance’s Medigap Number at the virtual level in HARP with the new five-digit Medigap ID by October 1st. If any insurance has a Medigap Number specified at the client level, it should either be removed or updated to the new Medigap ID.

Medigap ID Implementation Timeline

• By August 31, 2007:  The new Medigap claim-based IDs are assigned. Refer to http://www.cms.hhs.gov/COBAgreement/Downloads/Medigap Claim-based COBA IDs for Billing Purpose.pdf  for a listing of these new IDs.
• September 28, 2007: Quadax will update the virtual insurance Medigap Numbers in HARP for Manager and Partner clients, and Standalone clients should update their own.
• October 1, 2007:  The new Medigap IDs are required on Medicare claims—any claims with the old numbers will not successfully cross over to the Medigap insurer.

If you have any questions about how this change will affect you, please contact your Quadax Service Consultant. Details about the Medigap crossover process are available from CMS at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5601.pdf.