Secondary Claims (Crossovers) FAQs

There are two ways Medicare secondary claims are sent or “crossed over” to Medicaid. Either they are sent to Medicaid directly from a Medicare carrier, such as with most professional and inpatient claims, or they are sent to Medicaid from the provider through the NCTracks provider portal, a billing agent or trading partner/clearinghouse, such as with outpatient claims.

1. 1. Missing Billing or Rendering Provider Taxonomy Codes
   2. Billing NPI submitted with Rendering Provider Taxonomy Code (or vice versa)
   3. Invalid Taxonomy Code submitted with Billing or Rendering NPI

All secondary claims should be billed with the appropriate Billing AND Rendering Provider Taxonomy Codes from the NCTracks provider record.

No. These claims are sent to Medicaid either through the providers billing agent or trading partner/clearinghouse or the NCTracks provider portal. 

These claims should be resubmitted to Medicaid either through the provider’s billing agent or trading partner/clearinghouse or the NCTracks provider portal.

All information submitted to the primary payer should be retained and passed on to Medicaid, even though it might be information the primary payer does not require. Providers should contact their Medicare carrier or their billing agent or trading partner/clearinghouse if they suspect that data is not being passed to Medicaid.

Yes. If your claim is submitted to Medicaid either as a crossover or as a secondary claim, without taxonomy codes, it will be denied. The claim can be resubmitted with correct billing and rendering taxonomy codes.

Taxonomy codes provide a standard provider classification system and are a fundamental construct used throughout the Medicaid claims billing system, NCTracks taxonomy codes are connected to provider records, benefit plans, procedure codes, fee schedules, and claim adjudication rules.

The Provider Taxonomy Lookup page has been retired.  Providers should use the Status & Management page in the secure NCTracks Provider Portal to verify the taxonomy code(s) associate with their NPI.

No. Medicaid is the payer of last resort and providers who accept Medicaid patients agree to take assignment from Medicaid.  Providers cannot charge the patient for the balance of what is not paid by Medicaid.

Secondary claims can be submitted or resubmitted to NCTracks either as an X12 transaction or through the Provider Portal with the assistance of a billing agent/ clearinghouse or directly. If you wish to bill X12 transactions directly to NCTracks, without use of a clearinghouse, you will need to set up a TPA and complete the testing and certification process.

Medicaid will process Medicare secondary claims even if they include procedure codes that Medicaid doesn’t cover; however, all services billed to Medicaid are subject to Medicaid policy and may be denied by Medicaid even if they are covered by Medicare.

The time frame for claim submission is 6 months/180 days for all secondary claims and 365 days for Medicaid primary claims. For more information, please see the How to Submit Claim Adjustments and Time Limit and Medicare Override Job Aid under the heading Claims Submission on the User Guides & Fact Sheets page.

Loop 2320 contains the Other Subscriber Information. Please refer to the HIPAA 837 Companion Guides on the Trading Partner Information page of the NCTracks Provider Portal for more details.

The Medicaid Fee Schedules showing the Medicaid allowable amounts are posted on the NC Division of Health Benefits website at https://medicaid.ncdhhs.gov/providers/fee-schedule-index.

If the billed services are covered by Medicaid and the claim meets all the criteria for reimbursement then the status of the claim is paid, even if the Medicaid allowable amount is calculated as $0.

These $0 paid claims will be found in the paid section of the Medicaid EOB/RA.

This is a known issue with durable medical equipment claims. NCTracks edits all fields on a claim, including claims crossed over from Medicare. It is necessary to make these secondary claims “NC Medicaid ready”.

To make a claim “NC Medicaid ready”:

• Include a third level NC Medicaid Taxonomy
• Add the appropriate NC Medicaid modifier in the first modifier position
• Indicate the span of from and to dates the rental item was used for the month being billed– (NC Medicaid pays a prorated monthly amount based on the number of days the equipment was used during the PA period)
• Avoid spanning across months within the date range on a given line item (e.g.: 2/20/19-3/19/19 should be billed on two separate lines - one line for February and one line for March)
• Enter units equal to one for each rental month per line

Yes. The EOB Code Crosswalk to HIPAA Standard Codes can be found on the Provider Policies, Manuals and Guidelines page of the NCTracks Provider Portal at https://www.nctracks.nc.gov/content/public/providers/provider-manuals.html.

Please contact the NCTracks Call Center (1-800-688-6696) with any questions regarding billing or processing of secondary crossover claims.

The recommend browsers for NCTracks can be found using the System Requirements link at the bottom of every NCTracks webpage - https://www.nctracks.nc.gov/content/public/system-requirements.html.

It is not typically required for payment but there may be some circumstances where an EOB is needed. For more information, please see the How to Indicate Other Payer Details Job Aid under the heading Claims Submission on the User Guides & Fact Sheets page.

If you are submitting the original claim to NCTracks with secondary information, document only the recoupment details for the primary payer. If you previously submitted the original claim indicating a payment by the primary payer, submit a replacement claim and indicate the recoupment details.

Go to the Provider Communication page on the NCTracks Provider Portal.  On the upper right side of the page under the header "Sign up for NCTracks Communications", click “Click here to join Mailing list”. You will be asked to provide your email address, which will add you to the listserv to receive future provider communications, including the weekly newsletter.