IndianaAIM, the Indiana Medicaid Management Information System, has now been updated to accept secondary electronic crossover claims following adjudication by a Medicare Replacement Plan.
In July 2012, Indiana Health Coverage Programs (IHCP) announced that Medicare Replacement Plan claims submitted to IHCP would be processed just like Medicare crossover claims, eliminating the need to submit paper claims, attach explanations of benefits, or handwrite “Medicare Replacement” in the claim note field if paper claims were submitted.
However, the IndianaAIM system was not set up to accept the proper claim filing indicator code for Health Maintenance Organization (HMO) Medicare Risk. Providers submitting these claims electronically were instructed to hold affected claims.
The IHCP has announced that the issue has now been resolved and Medicare Replacement Plan claims submitted electronically via 837 or via Web interChange on or after September 1, 2013, must include claim filing indicator code 16–Health Maintenance Organization (HMO) Medicare Risk. Claim filing indicator codes MA and MB should continue to be used for original Part A and Part B Medicare claims filed electronically.
The IHCP reimburses covered services for Medicare or Medicare Replacement Plan crossover claims only when the Medicaid-allowed amount exceeds the amount paid by Medicare. If the Medicaid-allowed amount exceeds the Medicare or Medicare Replacement Plan paid amount, the IHCP reimburses using the lesser of the coinsurance plus deductible or the Medicaid-allowed amount minus the Medicare or Medicare Replacement Plan paid amount. This change also affects claims paid at zero when the amount allowed has been allocated to the member’s deductible.
For more information about submitting Medicare or Medicare Replacement Plan claims to IHCP via IndianAIM, please review the IHCP bulletin #BT201339 issued on July 30, 2013.
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