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This article is to reinforce the appropriate procedures for submitting
claims under a member's Medicare supplemental plan (e.g., MedigapSecurity,
Security 65®). Medicare supplemental claims that are not
submitted correctly will be rejected.
How Medicare supplemental claims are processed
The Centers for Medicare & Medicaid Services (CMS) is the primary payer for
Medicare supplemental claims. Independence, the secondary payer, uses the CMS
crossover process to receive Medicare supplemental claims. As part of this
process, CMS sends claims directly to Independence for members who have a
Medicare supplemental plan.
After the claim has been adjudicated by CMS, Independence enforces a 30-day
window from the Medicare remittance date (i.e., the date the claim was
finalized by CMS). This 30-day window does the following:
- allows CMS sufficient time to crossover the claim to Independence and for
Independence to complete secondary adjudication;
- prevents duplicate claims and ensures correct pricing.
Medicare supplemental claim rejections
Medicare supplemental claims may be rejected if the provider submits the
Medicare supplemental claim to CMS and then submits it to Independence for
payment prior to the end of the 30-day window. Providers receive rejections for
these claims through the 277CA transaction (for migrated members), U277
transaction (for non-migrated members), or Rejected Claims Report (for
non-migrated member claims sent via a UB-04 claim form).
For more information
For more information about the 277CA or U277 transactions, please refer to
the appropriate guide in the EDI
section of our website. For more information about our member migration to
the new operating platform, visit our
Business
Transformation site.
Please contact your Network Coordinator if you
have any questions about the claims submission procedures for Medicare
supplemental claims.
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