INSTRUCTIONS FOR FILING MEDICARE PART B PAPER CLAIMS
A provider should file a paper crossover claim to Medicaid if:
• Sixty days have elapsed since receiving a Medicare payment without receiving a payment from Medicaid; or
• The provider knows his intermediary or carrier does not forward claims to Missouri Medicaid.
Mail crossover claims to:
Infocrossing Healthcare Services P.O. Box 5600 Jefferson City, MO 65102
To submit a Medicare Part B paper crossover claim, the provider should attach a Part B crossover sticker to a copy of the Medicare Remittance Advice (RA) or the recipient’s Explanation of Medicare Benefits (EOMB) that indicates Medicare payment. The Part B sticker is identified with blue ink and is titled Medicare Part B/Medicaid-Title XIX. Place the sticker so it does not cover the recipient’s identifying information or the claim payment information on the RA/EOMB. Legible photocopies are acceptable (but not preferred) and must be securely affixed (NOT stapled) to the Medicare RA or EOMB
A provider should file a paper crossover claim to Medicaid if:
• Sixty days have elapsed since receiving a Medicare payment without receiving a payment from Medicaid; or
• The provider knows his intermediary or carrier does not forward claims to Missouri Medicaid.
Mail crossover claims to:
Infocrossing Healthcare Services P.O. Box 5600 Jefferson City, MO 65102
To submit a Medicare Part B paper crossover claim, the provider should attach a Part B crossover sticker to a copy of the Medicare Remittance Advice (RA) or the recipient’s Explanation of Medicare Benefits (EOMB) that indicates Medicare payment. The Part B sticker is identified with blue ink and is titled Medicare Part B/Medicaid-Title XIX. Place the sticker so it does not cover the recipient’s identifying information or the claim payment information on the RA/EOMB. Legible photocopies are acceptable (but not preferred) and must be securely affixed (NOT stapled) to the Medicare RA or EOMB
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