January 20, 2005
MCS Crossover Process Information
CIGNA Government Services sends adjudicated Medicare claims information to secondary insurance companies for their benefit determination. This process is called Coordination of Benefits (COB) or crossover. There are three types of COB: Complementary Crossover, Medicaid Crossover and Medigap Crossover.
Reminder!
CMS has decided to streamline the claims crossover process to better serve our customers. During 2005 year each COB trading partner will now enter into one national Coordination of Benefits Agreement (COBA) with CMS' consolidated claims crossover contractor, the Coordination of Benefits Contractor (COBC). Medigap crossover process will be change in the future but for the year 2005 will be the same.
CMS will provide generic Medicare Summary Notice (MSN) and Remittance Advice (RA) messages for claims transmitted to the COBC for crossover purposes and we will keep you informed of the changes to the current process. You will continue to contact the Medicare carrier Customer Service department for your questions about an individual's crossover status.
Please watch for future communication regarding this change.
Complementary Crossover
Complementary crossover is the transfer of adjudicated Medicare claims information based upon eligibility data supplied to CIGNA Government Services by the secondary insurance companies called Trading Partners. We have service agreements with Trading Partners for automatic crossover of the claim information. According to the agreement, companies provide us with an eligibility file on a weekly or monthly basis that lists all beneficiaries that are eligible for their insurance coverage. CIGNA Government Services' crossover process is designed to match the Health Insurance Claim Number (HICN) on the adjudicated claims with the HICN provided on the eligibility files from the Trading Partners. CIGNA Government Services can not change, update or delete any records from the trading partner's eligibility file according to the service agreement. All Complementary claim crossover files are sent each week for both assigned and non-assigned claims. No additional information is needed on the claim for the complementary crossover process to occur.
The Medicare Remittance Notice (MRN) identifies Complementary Crossover claims using the following ANSI code: MA18 for claims that have been crossed to complementary insurance companies.
Some claims can be excluded from the crossover process.
- The Trading Partner can specify that the following claims will
be excluded from the crossover process:
- 100% paid claims
- 100% denied claims
- Claims denied for certain reasons, i.e., as exact duplicates, routine services, etc.
- Adjustments
- Non-assigned claims
- MSP claims
- 2. In the MCS system, a patient's first Medicare claim establishes the beneficiary's claim history. Afterward, Medicare uses this history to indicate a Crossover eligibility record. If a beneficiary has no Medicare history available, the insurer's individual record for that beneficiary will remain unidentified. Until Medicare claim history is established, the identification of supplemental Crossover eligibility will be unavailable. Medicare performs routine eligibility updates using each company's most recent eligibility data. This minimizes the number of occurrences of this first claim situation. Companies send their eligibility file on a weekly or monthly basis.
Complementary Companies as of December 2004
| AAG Benefits Administrators | GEHA |
| AARP Operations | Great West |
| AEGON | Group Health Inc. |
| Aetna Healthcare | Health Care Service Corporation |
| AFLAC | Health Scope Benefit |
| AFSA | Highmark Life & Casualty |
| Aid Association for Lutherans | Highmark Services Insurance |
| Allied Benefits System | Humana Inc |
| Alternative Professional Services Inc. | ITT Hartford |
| Amalgamated Life | Kanawha Ins. Co. |
| American Capitol | Kenyon College Retirees |
| American Family | KPS Health Plans |
| American General | Life Insurance CO of Georgia |
| American Insurance Admin Group | Lincoln Heritage Life Insurance |
| American Legion | Medico Life |
| American Medical Association | Mennonite Mutual Aid |
| American National Ins. Co. | MOAA |
| American Republic Ins. Co. | Monumental Life |
| Amerihealth | Mutual of Omaha (Group) |
| Anthem FEP | Mutual of Omaha (Individual) |
| APWU Health Plan | Mutual Protective |
| Assoc Doctors Health and Life | National Assoc. of Letter Carriers |
| Atlantic American | Nationwide Health Plans |
| AUSA | NEA |
| Bankers Fidelity Life and Casualty | New Era Life Enterprise |
| BC California | NGS American |
| BC Idaho | North American Insurance |
| BCBS of Alabama | North American Health Plans |
| BCBS of Arkansas | Olympic |
| BCBS of Delaware | Oxford Life Insurance |
| BCBS of Florida | PacifiCare Health Plan Admin. |
| BCBS of Illinois | Pekin Life Insurance |
| BCBS of Iowa | Peoples Benefit Life Ins. |
| BCBS of Kansas | Physicians Mutual Insurance Company |
| BCBS of Massachusetts | Pioneer |
| BCBS of Michigan | POMCO |
| BCBS of Minnesota | Preferred Health Systems |
| BCBS of Mississippi | Premera Blue Cross |
| BCBS of New Jersey | Principal Financial Group |
| BCBS of New Mexico | Principal Life Insurance |
| BCBS of North Carolina | Pyramid |
| BCBS of North Dakota | Regence BS |
| BCBS of Oregon Regence | Regence BS ID Federal Employees |
| BCBS of Rhode Island | Regence BS of Idaho |
| *BCBS of Tennessee (Only State Employees/Retirees) | Regence BS WA FEP |
| BCBS of Texas | Retiree Medical Plans |
| BCBS of Utah Regence | ROA |
| BCBS of West Virginia | SAMBA |
| BCBS of Wisconsin | Savers Life Insurance |
| Benefit Planners Limited | State Farm Insurance Company |
| BeneSys Inc. | State Mutual Insurance |
| BS California | Stirling and Stirling |
| C&R Consulting | Thrivent Financial |
| Capitol Blue Cross | TMG Health |
| Carefirst BCBS ( NC claims only) | TRICARE |
| Celtic Life Insurance | Unicare |
| Central Benefits Life Insurance | Unified Life Insurance Company |
| Central States Health & Life of Omaha | Union Bankers/PMSC |
| Christian Fidelity Insurance | Union Fidelity |
| CIGNA | Union Fidelity Life Insurance |
| CAC/Mail Handlers | United American Ins. Co. |
| Comprehensive Benefits | United Commercial Travelers |
| Continental General Insurance Co. | United HealthCare |
| Continential Life Ins. Co. | United Medical Resources |
| Coresource | United Methodist Church |
| Country Life Insurance | United Teacher Associates Insurance Company |
| Empire HealthChoice Inc. | USAA Life Insurance Co. |
| Epoch Group | USAble Life Insurance |
| Equitable | Wakely and Associates |
| Federal Home Life Insurance | Wausau Company |
| FRA | Westport Benefits |
| GE Capitol Assurance | World Insurance Company |
| GE Life Assurance and Annuity | Worldnet Services Corp |
| Gilsbar Ins |
Medicaid Crossover
Medicaid Crossover is the transfer of adjudicated Medicare claims information based upon eligibility data supplied to CIGNA Government Services by the State Medicaid Agency. We have a standard Trading Partner Agreement (TPA) with Medicaid Agencies for automatic crossover of claim information. All Medicaid claim crossover files are sent each week, but only for assigned claims.
The Medicare Remittance Notice (MRN) identifies Medicaid crossover claims using the following ANSI code: MA07 for claims that have been crossed successfully to Medicaid. The MRN will not have the name of the Medicaid Agency.
Medicaid Agencies as of January 2005
Medicaid Idaho
Medicaid North Carolina
Medicaid Tennessee (TennCare Bureau)
Medicaid Kentucky in testing mode
Medigap Crossover
MCS system will not change Medigap Crossover process but new OCNA will required because MCS allows only 5 characters for OCNA.
Important dates! You should begin to submit the new OCNA as indicated below:
TN/ID transition to MCS on 02/01/05
| 1/19/2005 | - All paper claims received and controlled on or after this date will be processed in the MCS system following cutover. |
| 1/26/2005 | - All EMC claims received and controlled on or after this date will be processed in the MCS system following cutover. |
NC transition to MCS on 03/01/05
| 2/16/2005 | - All paper claims received and controlled on or after this date will be processed in the MCS system following cutover. |
| 2/23/2005 | - All EMC claims received and controlled on or after this date will be processed in the MCS system following cutover. |
The term "Medigap" refers to Medicare supplemental policies that are private health insurance plans designed to supplement Medicare benefits by filling in some of the "gaps" in Medicare coverage. This type of policy typically covers the coinsurance amount (20%) that Medicare did not pay or the amount applied toward the beneficiary's deductible. Medigap crossover is designed to lessen paperwork for the provider/supplier and beneficiary community and as an incentive for those entities who elect to be participating providers/suppliers in the Medicare program.
Medigap crossover is the transfer of adjudicated assigned claims information to the insurance companies that offer Medigap coverage. Medigap crossover only occurs based upon information submitted on the claim by the provider.
There are several criteria involved in a successful crossover of claims data to Medigap insurance companies:
- The provider/supplier must be participating in the Medicare program.
The claims will be assigned.
- For ANSI format in 2300 loop (Claim Information) element CLM07 = A and 2320 (Other Subscriber Information) element OI04 = B
- The word "Medigap" (or an abbreviation of the word; e.g., MG)
and individual Medigap policy number must be present on the claim
in the following places:
- For paper claims in Item 9A of the CMS-1500 form;
- For ANSI format in 2320 loop (Other Subscriber Information) element SBR05 = MI and 2330A loop (Other Subscriber Name) element NM108=MI and element NM109 = Medigap policy number
- The OCNA (Other Carrier Name and Address) number must be present
on the claim in the following places:
- For paper in Item 9D on the CMS-1500 form;
- For ANSI format in 2330B loop (Other Payer Name) element NM103 = Payer Name, element NM108=PI and element NM109 = OCNA
- The beneficiary must authorize the Medigap insurer to make benefit
payments to providers.
- The beneficiary may sign the CMS 1500 claim form at item 13. The beneficiary may sign a one-time signature authorization that the provider/supplier will keep on file. If the one-time authorization is used "signature on file" may be entered in block 13 of the CMS 1500 form.
- For ANSI format in 2300 loop (Claim Information) element CLM08 = Y and in 2320 loop (Other Subscriber Information) element OI03 = Y
Important! Please use the correct individual Medigap Policy number from the patient's insurance card because the Medigap company will not pay on the crossover claims if the claim doesn't have a valid individual Medigap Policy number. Our system does not validate Medigap Policy numbers. We are sending the information that was received on Medigap claims.
Tip! When selecting a Medigap OCNA number, you need to match the name and the address of Medigap Company from the patient's insurance card. If you can not find the match, please be sure to check the list of Complementary Crossover Companies.
OCNA list as of January 2005 for TN/ID and NC
| Name | New MCS OCNA | Old VMS OCNA | Address | City | State | ZIP |
|---|---|---|---|---|---|---|
| ACADEMY LIFE INC CO | MG049 | 30328A001 | UNITED TEACHER ASSOC PO BOX 26580 | AUSTIN | TX | 787550580 |
| ADVANCED INS SVC/BENEFIX | MX036 | 38101A001 | 85 N. DANNY THOMAS BLVD | MEMPHIS | TN | 381032398 |
| AMER ASSOC UNIV WOMEN | MX064 | 50398A001 | 1776 WEST LAKES PKWY | DES MOINES | IA | 50398 |
| AMER COMBINED LIFE | MX006 | 19047A001 | PO BOX 1009 | LANGHORNE | PA | 190476009 |
| AMER GEN LIFE & ACC INS | MX009 | 19049A001 | PO BOX 10845 | CLEARWATER | FL | 337578845 |
| AMER GENERAL GRP INS | MX091 | 75266A001 | PO BOX 660238 | DALLAS | TX | 752660238 |
| AMER GENERAL LIFE & ACC | MX021 | 28816A001 | PO BOX 6855 | ASHEVILLE | NC | 288166855 |
| AMER GENERAL LIFE & ACC | MX095 | 77251A001 | PO BOX 1931 | HOUSTON | TX | 772511931 |
| AMER INCOME LIFE INS | MG131 | 76702A001 | PO BOX 2608 | WACO | TX | 767022608 |
| AMER INS CO OF TX | MX092 | 75266A002 | PO BOX 660254 | DALLAS | TX | 752660254 |
| AMER TRAVELLERS INS | MG023 | 19020A001 | PO BOX 10319 | DES MOINES | IA | 503060319 |
| AON SELECT, INC | MG103 | 64111A001 | 406 W 34TH ST | KANSAS CITY | MO | 64111 |
| BANKERS LIFE & CASUALTY | MG098 | 60630B001 | 540 NORTH COLLEGE DR D1C | CARMEL | IN | 460324911 |
| BCBS OF ARIZONA | MG144 | 85069B001 | P O BOX 37700 | PHOENIX | AZ | 850690000 |
| BCBS OF GEORGIA | MG051 | 31908B001 | P O BOX 7368 | COLUMBUS | GA | 31999 |
| BCBS OF KANSAS CITY | MG105 | 64141B001 | PO BOX 419169 | KANSAS CITY | MO | 641416169 |
| BCBS OF LOUISIANA | MG113 | 70898B001 | PO BOX 98029 | BATON ROUGE | LA | 708989029 |
| BCBS OF MEMPHIS | MX037 | 38101B001 | PO BOX 98,79,10,30 | MEMPHIS | TN | 381010097 |
| BCBS OF MONTANA | MG094 | 59403B001 | PO BOX 5004 | GREAT FALLS | MT | 594035004 |
| BCBS OF NEW HAMPSHIRE | MG003 | 03306B001 | 3000 GOFFS FALLS ROAD | MANCHESTER | NH | 031110001 |
| BCBS OF NEW YORK | MG008 | 10036B001 | 320 W 46TH ST 4TH FL | NEW YORK | NY | 100363845 |
| BCBS OF NEW YORK | MG012 | 13221B001 | 344 S WARREN ST | SYRACUSE | NY | 132214809 |
| BCBS OF NEW YORK | MG013 | 13502B001 | 12 RHOADS DR | UTICA | NY | 135026306 |
| BCBS OF NEW YORK (EMPIRE} | MG010 | 10943B001 | 75 CRYSTAL RUN RD | MIDDLETOWN | NY | 109430001 |
| BCBS OF OHIO | MG064 | 43085B001 | 6740 N HIGH ST | WORTHINGTON | OH | 430852536 |
| BCBS OF PENNSYLVANIA | MG016 | 17407B001 | 70 MAIN ST N | WILKES BARRE | PA | 17407 |
| BCBS OF SOUTH CAROLINA | MG044 | 29260B001 | PO BOX 6000 | COLUMBIA | SC | 292606000 |
| BCBS OF TENNESSEE | MG061 | 37402B001 | 801 PINE ST | CHATTANOOGA | TN | 374023958 |
| BCBS OF VERMONT | MG004 | 05601B001 | PO BOX 186 | MONTPELIER | VT | 056010186 |
| BCBS OF WYOMING | MG137 | 82003B001 | PO BOX 2266 | CHEYENNE | WY | 833030489 |
| BENEFIX | MX039 | 38101B003 | 85 N DANNY THOMAS BLVD | MEMPHIS | TN | 381032398 |
| BLUE CROSS OF CONNECTICUT | MG005 | 06473B001 | P0 BOX 122 | NORTH HAVEN | CT | 06473 |
| CAL FARM LIFE INS CO | MG152 | 95851C001 | PO BOX 15016-1016 | SACREMENTO | CA | 958510000 |
| CATHOLIC GOLDEN AGE INS | MG019 | 18503C001 | 400 LACKAWANNA AVE | SCRANTON | PA | 185032014 |
| CERTIFIED LIFE INS CO | MX074 | 60630C001 | 222 MERCHANDISE M PLA | CHICAGO | IL | 606540000 |
| CERTIFIED LIFE INS CO | MX090 | 75265C001 | PO BOX 650209 | DALLAS | TX | 752655433 |
| CNA/CONTINENTAL CASUALTY | MX024 | 32859C001 | PO BOX 593925 | ORLANDO | FL | 328593925 |
| COLONIAL PENN INS CO | MX012 | 19181C001 | 1818 MARKET ST 25TH FL | PHILADELPHIA | PA | 191810000 |
| COMBINED INS CO OF AMER | MX007 | 19047C001 | PO BOX 568 | LANGHORNE | PA | 190470568 |
| COMMONWEALTH NATL LIFE IN | MX041 | 38732C001 | CENTRAL UNITED LIFE 2727 ALLEN PARKWAY | HOUSTON | TX | 77019 |
| COSMOPOLITAN INC CO | MX106 | 91365C001 | PO BOX 4171 | WOODLAND HLS | CA | 913654171 |
| DALLAS GENERAL LIFE | MG120 | 75221D001 | PO BOX 1080 | DALLAS | TX | 752219047 |
| DIRECT RESPONSE | MG089 | 55438D001 | 7930 CENTURY BLVD | CHANHASSEN | MN | 553178000 |
| DURHAM LIFE INS CO | MG036 | 27627D001 | PO BOX 61 | DURHAM | NC | 277020061 |
| EDUCATORS MUTUAL | MG141 | 84107E001 | 852 ARROWHEAD LN | MURRAY | UT | 841075211 |
| FEDERAL HOME LIFE INS | MX025 | 32887F001 | 6277 SEA HARBOR DR | ORLANDO | FL | 32887 |
| FORTIS FAMILY | MG045 | 29602F001 | P O BOX 19061 | GREENVILLE | SC | 296029061 |
| FRA MILICARE | MX016 | 20063F001 | 3100 M STREET NW | WASHINGTON | DC | 20063 |
| GEORGIA LIFE & HLTH INS C | MG048 | 30301G001 | PO BOX 4884 | HOUSTON | TX | 772104884 |
| GOLDEN RULE INS CO | MG075 | 46278G001 | 7440 WOODLAND DR | INDIANAPOLIS | IN | 462781720 |
| GOLDEN RULE INS CO | MX076 | 62439G001 | 712 11TH ST | LAWRENCEVILLE | IL | 641112736 |
| GOOD SAM INS CO | MG150 | 93121G001 | PO BOX 21807 | SANTA BARBARA | CA | 931211807 |
| GUARANTEE RESERVE LIFE | MX073 | 60409G001 | 530 RIVER OAKS W | CALUMET CITY | IL | 604095407 |
| GUARANTEE TRUST LIFE INS | MG095 | 60025G001 | 1275 MILWAUKEE AVE | GLENVIEW | IL | 600251500 |
| GULF LIFE INS CO | MX033 | 37250G001 | AMERICAN GENERAL CTR | NASHVILLE | TN | 372500001 |
| HAWAII MEDICAL SRV ASSOC | MG153 | 96808H001 | PO BOX 860 | HONOLULU | HI | 968080860 |
| INTEGRITY NATL LIFE INS | MX045 | 40232I001 | PO BOX 32350 | LOUISVILLE | KY | 402322350 |
| LIBERTY LIFE INS CO | MG046 | 29602L001 | COMPANION LIFE PO BOX 100133 | COLUMBIA | SC | 292023133 |
| LIFE INS CO OF VIRGINIA | MX010 | 19053L001 | 4850 E STREET RD | FSTRVL TRVOSE | PA | 190536646 |
| MILICARE | MX017 | 20063M001 | 2100 M STREET N.W. | WASHINGTON | DC | 20063 |
| MILICARE/FLEETRESERVE | MX018 | 20063M002 | 3060 WILLIAMS DR ST.3 | FAIRFAX | VA | 20063 |
| MONUMENTAL GENERAL INS CO | MG031 | 21201M001 | 1111 N CHARLES ST | BALTIMORE | MD | 212015544 |
| NATL BENEFIT CORP | MX077 | 64111N001 | 406 W 34TH ST | KANSAS CITY | MO | 64111 |
| NATL FINANCIAL INS CO | MG126 | 75266N001 | 110 WEST 7TH ST STE 300 | FORT WORTH | TX | 76102 |
| NATL FOUNDATION LIFE | MG128 | 76102N001 | 801 CHERRY ST UNIT 33 | FORT WORTH | TX | 76102 |
| NATL LIFE & ACC | MX034 | 37250N001 | M/C 1512 AMERICAN GENERAL CTR | NASHVILLE | TN | 374022520 |
| NATL SECURITY LIFE & ACCI | MG127 | 76015N001 | PO BOX 149151 | AUSTIN | TX | 787149151 |
| OLD AMER INS CO | MG106 | 64141O001 | 3520 BROADWAY PO BOX 418573 | KANSAS CITY | MO | 652180001 |
| OLD SURETY LIFE INS CO | MG117 | 73154O001 | PO BOX 54407 | OKLAHOMA CITY | OK | 731541407 |
| PENINSULAR LIFE INS CO | MG035 | 27605P001 | 1001 WADE AVE | RALEIGH | NC | 27605 |
| PENN TREATY LIFE INS CO | MG018 | 18103P001 | 3440 LEHIGH ST | ALLENTOWN | PA | 181037001 |
| PEOPLES SECURITY LIFE INS | MG039 | 27702P001 | PO BOX 61 | DURHAM | NC | 27702 |
| PERSONAL HEALTH CARE | MG032 | 24038P001 | PO BOX 14046 | ROANOKE | VA | 240384046 |
| PROTECTED HOME MUT LIFE | MG015 | 16146P001 | 30 E STATE ST | SHARON | PA | 161461705 |
| PROVIDENTIAL LIFE INS CO | MG115 | 72203P001 | P O BOX 66967 | CHICAGO | IL | 606660967 |
| RESERVE NATL LIFE IN | MG116 | 73118R001 | 6100 NW GRAND BLVD | OKLAHOMA CITY | OK | 731250097 |
| SECURE HORIZONS HLTH PL | MG147 | 90630S001 | 5995 PLAZA DR | CYPRESS | CA | 906300489 |
| SENTRY LIFE INS | MG084 | 54481S001 | 1800 NORTH POINT DR | STEVENS POINT | WI | 54481 |
| SHELTER LIFE INS CO | MG107 | 65218S001 | 1817 W BROADWAY | COLUMBIA | MO | 662023336 |
| SOUTHERN HEALTH PLAN | MX040 | 38101S001 | PO BOX 97 | MEMPHIS | TN | 381010097 |
| TRUSTMARK INS CO | MG096 | 60045B001 | 400 FIELD PO BOX 7900 | LAKE FOREST | IL | 600450000 |
| UNITED FAMILY LIFE INS | MX023 | 30301U001 | PO BOX 2204 | ATLANTA | GA | 303012204 |
| UNITED FARM BUREAU FAMILY | MG073 | 46206U001 | PO BOX 1250 | INDIANAPOLIS | IN | 462077025 |
| UNITED SEC ASSURANCE CO O | MG022 | 18964U001 | 673 E CHERRY LN | SOUDERTON | PA | 189641236 |
| UNIVERSAL FIDELITY LIFE | MX085 | 73533U001 | 2211 N HIGHWAY 81 | DUNCAN | OK | 735331222 |
| VFW MEDICARE SUPPLEMENT | MG104 | 64111V001 | C/O AON SELECT INC PO BOX 961085 | FORT WORTH | TX | 761610000 |
| WISCONSIN PHYSICIANS SERV | MX066 | 53701W001 | 1717 W BROADWAY | MADISON | WI | 53701 |
