BlueCard Claim Enhancements for Medicare Statutorily Excluded Services

Since January 1, 2006, all Blue Plans, including BCBSNC, are required to process Medicare-crossover claims for services covered under Medigap and Medicare Supplemental products through CMS.  This has resulted in automatic submission of Medicare claims to the Blue Plan secondary payer eliminating the need for the provider’s office or billing service to submit an additional claim to the secondary carrier. 

Beginning in October, the following Medicare-crossover servicing updates will be in place for all Blue Plans to more accurately price and process these claims:

• Starting October 13, 2013, providers should submit only those statutorily excluded services by Medicare to BCBSNC with a GY modifier on each line for the service that is excluded or not covered by Medicare.  This will allow BCBSNC to apply the contracted rate with the provider to accurately process the claim according to the member’s benefits.  Also, by submitting statutorily excluded services with a GY modifier directly to BCBSNC, you will receive payment for these services in a timelier manner.
• Additionally, when a provider submits a claim to Medicare for services statutorily excluded and not covered by Medicare, but the member has benefits for those services, providers will receive notification via either a paper or electronic remittance advice or letter from the Blue Plan with instructions to submit those statutorily excluded services directly to BCBSNC.