BlueCard^® and Medicare

The following are guidelines for the processing of traditional Medicare-related claims.   

When Medicare is the primary payor, submit claims to your local Medicare intermediary. All Blue claims automatically cross over to the member’s Blue Plan after being adjudicated by the Medicare intermediary.  

Include the prefix as part of the member identification number. The member’s ID will include the prefix in the first three positions. The prefix is critical for confirming membership and coverage, and key to facilitating prompt payments.  

When you receive the remittance advice from the Medicare intermediary, look to see if the claim has been automatically forwarded (crossed over) to the Blue Plan:

• If the remittance advice indicates that the claim was crossed over, Medicare has forwarded the claim on your behalf to the appropriate Blue Plan and the claim is in process. DO NOT file the claim to Blue Cross and Blue Shield of Nebraska (BCBSNE). 
• If the remittance advice indicates that the claim was not crossed over, submit the claim to BCBSNE with the Medicare remittance advice.  
• In some cases, the member identification card may contain a COBA ID number. If so, be sure to include that number on your claim.  
• Verify claim status by submitting a Claim Status Inquiry on NaviNet, or by calling GABBI (800-635-0579).  

Expect to receive payment:  

Claims submitted to the Medicare intermediary will be crossed over to the Blue Plan only after they have been processed. This process may take up to 14 business days. This means that the Medicare intermediary will be releasing the claim to the Blue Plan for processing about the same time you receive the Medicare remittance advice. As a result, it may take an additional 14-30 business days for you to receive payment from the Blue Plan.

What to do in the meantime: 

• If you submitted the claim to the Medicare intermediary/carrier and haven’t received a response to your initial claim submission, don’t automatically submit another claim.
• Review the automated resubmission cycle on your claim system.
• Wait 30 days.
• Check claim status before resubmitting.

Sending another claim or having your billing agency resubmit claims automatically slows down the claim payment process and creates confusion for the member. 

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