According to the Centers for Medicare and Medicaid Services (CMS), approximately 99% of all claims that Medicare identifies for crossover, as cited on provider Medicare Remittance Advice, are crossed over by CMS Coordination of Benefits Contractor (COBC). The crossover failures are due HIPAA compliance issues or related data errors and the provider will receive a Medicare-generated special notification specifying the reason.
CMS is requesting that providers allow time for the Medicare Claim Crossover Process to process before attempting to balance bill their patient supplemental insurers. This crossover process takes approximately 15 work days after Medicare's reimbursement is made, as stated in MLN Matters Article SE0909 (http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0909.pdf). CMS advises to balance bill after receiving written confirmation from Medicare that claims either did not cross over, or they have received a special notification letter explaining why specified claims cannot be crossed over. According to a CMS notification, Remittance Advice Remark Codes MA18 or N89 on your Medicare Remittance Advice (MRA) represent Medicare's intention to cross your patients' claims over. Medicare will continue to issue supplemental notifications to all participating providers, physicians, and suppliers informing them if claims targeted for crossover, as evidenced by MA18 or N89 on the MRA, do not actually result in successful crossover transmissions.