The Mississippi Medicaid Part B Crossover Claim form located in this section is a state specific form, and must be used when billing for Medicare Part C Advantage Plans only. Medicare Advantage Plans claims are for dually eligible beneficiaries enrolled in Medicare and eligible for Medicaid coverage. The following are instructions for completing the Medicare Part B crossover billing form when billing Medicare Part C Advantage Plan claims.
Paper Claim Reminders
Claims should be completed accurately to ensure proper claim adjudication. Remember the following:
* Use blue or black ink.
* Be sure the information on the form is legible.
* Do not use highlighters.
* Do not use correction fluid or correction tape.
* Ensure that names, codes, numbers, etc., print in the designated fields for proper alignment.
* Claim must be signed. Rubber signature stamps are acceptable.
* Claims received on an incorrect claim form or without the appropriate EOMB can not be processed for payment.
* Indicate that the claim is a Medicare Part C Advantage Plan claim by writing the words Advantage Plan on the bottom of the claim form.
Paper Claim Reminders
Claims should be completed accurately to ensure proper claim adjudication. Remember the following:
* Use blue or black ink.
* Be sure the information on the form is legible.
* Do not use highlighters.
* Do not use correction fluid or correction tape.
* Ensure that names, codes, numbers, etc., print in the designated fields for proper alignment.
* Claim must be signed. Rubber signature stamps are acceptable.
* Claims received on an incorrect claim form or without the appropriate EOMB can not be processed for payment.
* Indicate that the claim is a Medicare Part C Advantage Plan claim by writing the words Advantage Plan on the bottom of the claim form.
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