Does Medicare Automatically Send Claims to Secondary Insurance?

Medicare coordination of benefits with secondary insurers is a complex process that often leaves beneficiaries wondering if their claims will automatically crossover. The short answer is sometimes Medicare will automatically forward claims, but the rules vary depending on your situation. This article provides an in-depth look at how Medicare claim crossover works, when you can expect automated forwarding, and what to do if your secondary claim is not paid.

What is Medicare Crossover?

Medicare crossover is the process of forwarding your claim information from your primary Medicare coverage to your secondary insurer. This eliminates the need for you or your provider to submit the claim twice.

Crossover allows your secondary insurance (Medigap, employer insurance, Medicaid, etc.) to immediately process the remaining costs after Medicare has paid its share. This saves time and administrative hassle.

Medicare acts as the “primary payer,” meaning they pay first on your claim up to the Medicare approved amount. The claim details are then crossed over to your secondary payer to cover any remaining costs according to your policy.

When Does Medicare Automatically Crossover Claims?

Medicare uses several methods to coordinate benefits between plans. Automatic claim crossover depends on your specific coverage situation:

• Medigap or Medicare Supplement Plans – These policies are designed to work seamlessly with Medicare. Claims are automatically forwarded in most cases without any action needed on your part.

• Medicaid – For those dual eligible for Medicare and Medicaid, claims are automatically crossed over. Make sure both plans have your updated information for smooth processing.

• Medicare Advantage (Part C) – Since this is a consolidated plan administered by Medicare, there is no claim forwarding required. The plan pays according to its policy after Medicare processes its share.

• Employer Insurance – Group health plans do not receive automated crossover of Medicare claims. You will need to submit to the secondary manually in most cases.

• VA Benefits – Claims are not automatically forwarded to the VA. You must choose which coverage to use when obtaining care.

• Other Government Programs – Black lung benefits, Indian Health Services, Tricare, and similar programs also require separate claim filing.

Essentially, Medicare will automatically crossover to secondary insurers that are designed to supplement Medicare. For other coverage, you often need to file the secondary claim separately.

What is Needed for Automatic Medicare Crossover?

In order for Medicare to electronically forward your claims, a few requirements must be met:

• Accurate Medicare Beneficiary Information – Medicare relies on having your complete details including full legal name, date of birth, Medicare ID, and Social Security Number.

• Complete Provider Information – Your treating provider must submit accurate details on the claim including NPI number and complete address.

• Eligibility for Both Plans – You must be actively enrolled and eligible for benefits under both primary Medicare and your secondary insurance.

• Contracted Secondary Insurer – The secondary plan must have an established electronic crossover agreement with Medicare. Not all plans can receive automatic forwarding.

• Medicare Part B Enrollment – You typically need active Part B coverage for crossover claims to be sent from Medicare. Part A only is often not enough.

• No Mistakes or Incomplete Data – Any errors or missing information can prevent Medicare from processing the automated crossover.

As long as all the above conditions are satisfied, Medicare claims should transfer electronically to partners like Medigap plans. Problems arise when one of these requirements is not met.

Why Doesn’t Medicare Always Crossover My Claims?

Even if you have appropriate secondary insurance, you may find your claims are not automatically forwarded on some occasions. Here are some common reasons Medicare crossover might fail:

• Outdated Insurer Information – If Medicare does not have your current secondary insurer on file, the claim cannot send electronically. Update details through MyMedicare.gov.

• Non-Participating Secondary Insurer – As mentioned, the secondary carrier must have a crossover agreement with Medicare established. Not all do.

• Errors or Incomplete Claims Data – If any required Medicare or provider data is wrong or missing, that can prevent automated processing.

• Claims from Non-Assigned Providers – If your provider does not accept assignment with Medicare, crossover is less likely. Consider providers that directly bill Medicare.

• Other Primary Insurance – If you have another primary insurer, Medicare may not crossover remaining costs after that plan’s payment.

• Medicare Advantage Enrollment – Traditional Medicare won’t crossover if you switch to a Medicare Advantage Plan with all-in-one coverage.

Essentially any deviation from the optimal conditions for crossover can disrupt the automated process. When that happens, you need to take action to file the secondary claim.

How Do I Submit My Secondary Claim Without Crossover?

If your Medicare claim is not crossed over, here are your options to send the bill to your secondary insurer:

• File a Paper Claim – Download the CMS-1500 form to manually submit details from your Medicare Summary Notice.

• Submit Electronically – Providers can send 837 electronic claim files on your behalf if they are set up for this.

• Call Your Secondary Insurer – Ask them to trace Medicare’s forwarded notice and manually initiate payment.

• Use Provider Online Tools – Many doctor’s offices have patient portals that allow claim submission to secondary plans.

• Request Crossover Retroactively – You can ask Medicare to reprocess crossover if a claim mistakenly failed to send.

Don’t wait for your secondary claim to pay out automatically. Take action promptly if Medicare does not crossover within 1-2 weeks to avoid delayed reimbursement.

How Can I Check the Status of Medicare Crossover Claims?

You have a few options to verify whether Medicare has sent your claim details electronically:

• Review Your Medicare Summary Notices – These should note if claim information was forwarded.

• Check Your Secondary Insurer’s Website – Many let you view pending crossover claims online.

• Call Your Secondary Insurer – A representative can check if your Medicare claim is pending.

• Ask Your Provider – Doctors’ offices have tools to check crossover status.

• View MyMedicare.gov – This portal shows coordinated claims between plans.

• Contact the Benefits Coordination & Recovery Center – Call 1-855-798-2627 for crossover help.

Monitoring crossover activity this way helps identify any issues with automated forwarding early on. You can then take quick action to submit the secondary claim yourself.

How Do I Set Up Crossover to a Secondary Insurer?

If your Medicare claims have never successfully crossed over, you likely need to set up the process with your secondary insurer:

• Contact the Insurer – Ask them to initiate crossover setup on their end electronically.

• Provide Your Medicare ID – Share your Medicare number so both plans can link your policy records.

• Confirm Authorization – Medicare must authorize release of your claim data to the secondary plan.

• Update Your MyMedicare.gov Account – Add your secondary payer to enable claim forwarding.

• Fill Out a Crossover Form – Some insurers have forms to request crossover access from Medicare.

Coordination takes some time to establish, so address this early on to avoid manual claim submission. Proper crossover setup also simplifies renewal and policy changes.

Common Questions about Medicare Crossover

Many beneficiaries have additional questions about the coordination between their Medicare plan and secondary insurers:

Does Medicare crossover to VA benefits?

No, you need to file secondary claims directly with the VA after Medicare pays its share. The VA does not receive automated claim forwarding.

What if I have two secondary insurers?

Medicare will only crossover to one secondary payer. For any additional insurers, you need to submit claims yourself after the first secondary pays.

Can I opt out of Medicare crossover?

Yes, you can request Medicare not share your claim data if you prefer to independently submit secondary claims yourself.

What is the deadline for claim crossover?

Medicare aims to forward claims within 72 hours after initial processing. Secondary plans must pay within 60 days of receiving the crossover notice.

Do Medicare Advantage plans crossover claims?

No, since Medicare Advantage provides one consolidated plan, there are no secondary claims to forward after processing.

What if I’m retroactively enrolled in Medicare?

Claims can only crossover for dates where you have active Medicare coverage. There is no retroactive crossover for past claims.

Understanding the nuances of Medicare’s automated forwarding system can save you major headaches. Follow best practices to ensure your primary and secondary insurers coordinate smoothly.

Key Takeaways

• Medicare crossover automatically forwards claims from Medicare to secondary insurers like Medigap plans.

• Automatic forwarding works seamlessly for Medicare-connected policies but typically not employer group health plans.

• Crossover requires accurate data on your Medicare and secondary policy for electronic processing.

• If crossover fails, you must manually submit your claim to