Medicare Secondary Claims

Effective October 2013, the Blue Cross Blue Shield Association (BCBSA) implemented new regulations governing the submission process of Medicare Secondary claims.

Regulation Requirements

  • Wait 30 days from the Medicare Explanation of Benefits (EOB) date before submitting your secondary claim.
  • If you are submitting a secondary claim electronically (professional providers only), you must include the Medicare EOB or remittance advice date.
  • Out-of-area member claims for covered services are now rejected by the member's home plan. When you receive a rejection notification, you must resubmit these claims to CareFirst for processing through BlueCard®.
  • Medicare claims billed using a 'GY' modifier can be submitted directly to CareFirst without prior submission to Medicare. These claims are not impacted by the 30 day requirement and do not require the inclusion of a Medicare EOB.

How to Submit

All professional and institutional providers should submit Medicare Secondary claims electronically. If a paper claim is submitted, it must be accompanied by a copy of the Medicare EOB.

Electronic claims will need to contain specific information in the 837 claims transaction set. View the 837 Companion Guide for details.

Claims received without the required information will be returned at the front-end with one of the following messages:

  • 53815 or 53818 - Missing Primary Payer payment information
  • 53816 - Adjustment cannot be sent electronically
  • 53817 - Invalid Primary Payer Information
  • 53819 - Provider must accept assignment to send Medicare Crossover electronically

View the chart  for additional information on the front-end rejections. The rejection verbiage may differ depending on the trading partner.

As a reminder, you should always check CareFirst Direct or CareFirst on Call for claim status before submitting a secondary claim.