Medicare Crossover is the process by which Medicare, as the primary payer, automatically forwards Medicare Part A (hospital) and Part B (medical) claims, including Durable Medical Equipment (DME) claims, to Community Health Plan of Washington (CHPW) as the secondary payer for processing.

CHPW has entered into an agreement with Benefits Coordination & Recovery Center (BCRC) to electronically Crossover Part A and Part B claims from Medicare to CHPW beginning in June, 2018.

Who is Impacted

This change affects Medicaid members who are enrolled in Washington Apple Health and Integrated Managed Care who have traditional Medicare as their primary plan and CHPW as their secondary plan.

How it Works

CHPW sends a monthly enrollment file to BCRC identifying our Medicaid members that have traditional Medicare fee-for-service as their primary plan, and CHPW as secondary.

Providers, you must include the Medicare Health Insurance Claim Number (HICN) and/or Medicare Beneficiary Identifier (MBI) on all your claims where the member has dual coverage. This allows CHPW to confirm the member has Medicare as primary and crossover claims without delay.

When BCRC receives a claim for Medicare processing and the member has coverage with CHPW, BCRC will electronically send the claim and their explanation of benefits directly to CHPW for processing of the secondary benefit. Medicare claims are sent daily from BCRC to CHPW.

Benefits of the Crossover Process

This process eliminates the need for the member, provider, or facility to submit a claim twice: first to traditional Medicare, then to CHPW. No Medicare explanation of benefits (EOB) is needed to be sent to CHPW. This reduces administrative efforts for secondary claims submissions, as well as improves turnaround time and claims payment accuracy.

How to Know if the Medicare Claim Crossed Over to Medicaid

Your Medicare remittance or the 835 transaction will have remark code MA18 to indicate the claim was an automatic crossover to Medicaid/CHPW. When the indicator appears on the Medicare remittance, you will not bill CHPW directly for those members.

When CHPW processes a Medicare crossover claim, the claim number assigned will contain the characters of “MX” within the claim number. This is your notification the claim processed as secondary for Medicaid after Medicare.

Will my Medicaid Remittance Advice Change?

There will be no changes to the content of the CHPW Medicaid paper remittance advice or the CHPW Medicaid electronic 835 remittance.

Will Claims Adjustments be Crossed Over?

No, claim adjustments need to continue to be submitted the same way they are today.

What Claim Types Will Not be Crossed Over?

  • 100% denied claims with no additional beneficiary responsibility
  • MSP cost-avoided fully denied claims
  • Duplicate claims or claims with missing information
  • Claims paid at 100% by Medicare with no additional beneficiary responsibility
  • Claims outside of Medicaid eligibility begin and end dates
  • Health Home (not to be confused with Home Health)

Who Do I Contact for Questions?

Please contact Customer Service Monday – Friday, 8 a.m. to 5 p.m. via email to customercare@chpw.org, or call:

  • Washington Apple Health (Medicaid) Customer Service, (800)-440-1561
  • Integrated Managed Care (IMC) Customer Service, (866) 418-1009
  • Apple Health and IMC TTY /TDD users, dial 7-1-1

Claims Billing Tips:

  • Medicare remark code MA18 on the EOMB indicates the claim was sent by Medicare to the secondary payer. Allow an additional 15-30 days for CHPW to receive and process the crossover claim.
  • Claims should not be sent to CHPW that were crossed over by Medicare, as denoted by code MA18 on the EOMB. Sending another claim when one is already in our system will slow the payment process and create confusion for the member.
  • If code MA18 is not on the EOMB, the secondary claim can be filed electronically by the provider or billing entity
  • CHPW claim numbers will have the letters MX in our claim number to help identify Medicare Crossover claims.
  • Allow 15-20 days to receive and review the Explanation of Medicare Benefits (EOMB) from Medicare before filing the secondary claim to CHPW, if required.