Blue Cross Blue Shield Announces New Medicare Primary Duplicate Claim and Pricing Mandate Policy

Effective October 13, 2013, according to the Blue Cross and Blue Shield Association’s Medicare Primary Duplicate Claim and Pricing Mandate, all participating providers are required to follow new rules concerning Medicare secondary claim submission.

As of October 13, 2013, Blue Cross Blue Shield will deny secondary claims that are submitted less than 30 calendar days of the Medicare remittance date. Thus, providers will need to wait 30 calendar days from the Medicare remittance date before submitting claims to Blue Cross Blue Shield.

This policy may be an effort to streamline administrative processes. Medicare sends claims to secondary payers after they pay. Then, a secondary payer, such as Blue Cross Blue Shield may get the claims. Medicare identifies that the claim is a crossover claim but many systems don’t recognize that identification and a duplicate secondary claim might be sent to the payer. Under the new rule, the provider would receive payment on the claim before the end of the delay period and avoid problems and costs associated with duplicate claims.

For an example of the new policy outlined in BCBS Association’s Medicare Primary Duplicate Claim and Pricing Mandate, please click here.