 Medicare contractors have trading partner agreements with many private
insurers that offer supplemental health insurance that provide for the
electronic crossover of Medicare Part A (hospital) and Part B (medical) claim
data. Medicare beneficiaries are best served by having the Medicare contractor
file any supplemental insurance claims on their behalf, eliminating the need for
beneficiaries or providers to file such claims.
Under these arrangements, the supplemental insurer supplies the Medicare intermediary or carrier with an eligibility file. The file contains their subscriber information, including the beneficiaries' Medicare numbers and effective dates for supplemental coverage. On a daily basis, the eligibility file is run against the Medicare paid claims file. Claims are crossed electronically to the supplemental insurer if the Medicare HIC (Health Insurance Claim) number on the claim matches the subscriber's HIC number on the eligibility file and the dates of service on the claim are within the effective supplemental coverage dates. Claim criteria (types of claims to be crossed) is determined by the supplemental insurer. Page Last Modified: 01/30/07 |
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