Centers for Medicare and Medicaid Services has informed State Medicaid Agencies that effective May 23, 2008, Medicare will no longer accept or forward Wisconsin Medicaid provider numbers on Medicare claims that automatically crossover to Medicaid. Providers will be required to indicate their National Provider Identifier (NPI) and have the NPI on file with BadgerCare Plus for claims to ensure that claims will automatically crossover to BadgerCare Plus.
Medicare Discontinues Forwarding Claims Submitted with a Medicaid Provider Number
Effective May 23, 2008, Medicare will no longer accept or forward Wisconsin Medicaid provider numbers on automatic crossover claims in compliance with National Provider Identifier (NPI) implementation. Health care providers will be required to indicate their NPI for all primary and secondary provider fields when submitting claims to Medicare that automatically crossover to BadgerCare Plus. Additionally, providers must ensure that the NPI indicated on Medicare claims has been reported to BadgerCare Plus to ensure successful processing of crossover claims.
This change to processing procedures by Medicare may result in Medicaid crossover claims being denied if providers have not reported their NPIs to BadgerCare Plus.
Automatic Crossover Claims from Medicare
On 837 Health Care Claim: Institutional (837I) and 837 Health Care Claim: Professional (837P) transactions submitted to Medicare that automatically crossover to BadgerCare Plus, health care providers are required to adhere to the following NPI guidelines as they apply:
- Providers with one NPI corresponding to one Medicaid provider number will be required to indicate the NPI that they reported to Wisconsin Medicaid in the Billing Provider Secondary Identification element on the claim.
- Organizations that have identified subparts resulting in more than one NPI corresponding to one Medicaid provider number will be required to indicate the primary organizational NPI that was reported to Wisconsin Medicaid.
- Providers with one NPI corresponding to multiple Medicaid provider numbers are required to also indicate the taxonomy code and ZIP+4 code. Contract Information Segment (CN1) value code is also required for designated provider types as outlined in the April 2008 BadgerCare Plus Update (2008-30), titled "Implementation of National Provider Identifier."
Provider-Submitted Crossover Claims
A provider-submitted crossover claim is a Medicare-allowed claim that a provider directly submits to BadgerCare Plus when the Medicare claim did not automatically crossover to BadgerCare Plus. In instances when a claim does not automatically crossover and does not appear on the provider’s Remittance Advice after 30 days of the submission date, providers may initiate a provider-submitted claim in one of the following ways:
- 837 Health Care Claim: Institutional transaction, as applicable.
- 837 Health Care Claim: Professional transaction, as applicable.
- Provider Electronic Solution (PES) software.
- Paper claim form.
Standard Electronic Transactions
For provider-submitted 837I and 837P crossover transactions, the Medicaid provider number and/or NPI with related data will be accepted by BadgerCare Plus until implementation of ForwardHealth interChange in October 2008.
Provider Electronic Solutions Software
Provider Electronic Solutions is the Health Insurance Portability and Accountability Act of 1996-compliant claims software available to providers free of charge. The PES claims submission software will accept a Medicaid provider number or an NPI until implementation of ForwardHealth interChange in October 2008.
The PES software may be ordered online at www.wisconsinedi.org/pes/, or providers may call the Electronic Data Interchange Helpdesk at (866) 416-4979 to request a PES CD.
Paper Claim Form
Medicare crossover claims submitted on paper claim forms will not require an NPI. Paper claims will continue to require Medicaid provider numbers until implementation of ForwardHealth interChange in October 2008.
