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March 27, 2018

Spring OPPS Update Released

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Medicare Crossover Claims Hit Processing Glitch

February 23, 2010:

The Centers for Medicare and Medicaid Services (CMS) has indicated that due to a software snag, claims that Medicare contractors should have automatically sent to supplemental payers have not been sent, even though the remittance advice indicates otherwise. The problem began January 5, 2010, and has affected both Part A and Part B claims with the exception of those processed by durable medical equipment Medicare administrative contractors (DME MACs).

The agency indicates that when a remittance advice (RA) issued between January 5 and February 12 contains the following criteria, it was unable to forward the claim to the supplemental payer and providers should submit supplemental claims manually.

  • One service line is reimbursed at 100 percent.
  • One service line contains Medicare approved amounts that are applied to the patient’s deductible.

CMS fixed the problem, so any claims that should have crossed over after February 12 have done so.

Deborah C. Hall
Clinical/Technical Editor


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