Ordering Provider on Medicare Crossover Claims
July 28, 2016Due to a recent system change, Oklahoma Health Care Authority (OHCA) system now captures Medicare Crossover claim detail-level data and pays the claim at the detail level. In the past the OHCA paid the entire claim at the header level, so no ordering provider was required. If the provider does not include the ordering physician on the Medicare claim, then the crossover claim will deny with an error stating that there is no ordering physician listed (edit 1138). For claims that have denied for this reason, providers must void the claim, list the ordering provider, and resubmit. The provider can only void a claim if it is paid status. You can have a paid claim with details that denied for this reason, which is why they would need to void the claim, correct the denial and re-file a new claim.