How do I handle Medicare-related claims?

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Blue Plan is primary
Submit claims to your local Blue Plan—BCBSRI. Do not bill Medicare directly for any services rendered to a Medicare Advantage member.

Medicare is primary
When Medicare is the primary payer for an out-of-area Blue Plan member (e.g., Medigap plans), follow these procedures:

  1. Submit claims to your local Medicare contractor first. Do not file with Medicare and the supplemental insurer simultaneously. Be sure to include the:
    • complete Health Insurance Claim Number (HICN),
    • patient's complete ID number,
    • patient's name as it appears on the card.
  2. After you receive an Explanation of Medical Benefits (EOMB) or Medicare Remittance Notice (MRN), determine if the claim was automatically crossed over to the supplemental insurer:
    • Crossed over: If the indicator on the EOMB or MRN shows that the claim was crossed over, Medicare has forwarded the claim on your behalf to the appropriate Blue Plan and the claim is in process. You do not need to file for the Medicare supplemental benefits. The Medicare supplemental insurer will automatically pay you, if you accepted Medicare assignment. Otherwise, the member will be paid and you will need to bill the member.
    • Not crossed over: If the EOMB or MRN does not indicate the claim was crossed-over, file the claim as you do today to BCBSRI. BCBSRI or the member's Blue Plan will pay you the Medicare supplemental benefits. If you did not accept Medicare assignment, the member will be paid and you will need to bill the member.


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