How to avoid rejects of Medicare and Medicaid crossover claims

Are your Medicaid crossover claims rejecting?

If you answered yes, it may be due to the address you have on file with Medicare and Medicaid. When Medicare crosses over your claim to Medicaid the following address fields are submitted:

• Master address
• Pay-to (or remit address) (if they are different on Medicare's system)

If Medicaid does not have the same addresses in their file, Medicaid will reject the claim. 

Medicaid validates the crossover claims as follows:

• National provider identifier (NPI)
• NPI to taxonomy code (if applicable)
• NPI to ZIP code

What you can do to avoid rejects

• Verify you have the exact same addresses on file with both Medicare and Medicaid.
• Make sure your addresses are current and in the ZIP+4 (i.e., nine-digit ZIP code) format.

How to update your Medicare enrollment record

If you do not have the correct addresses on file with Medicare, please update your enrollment file by completing the appropriate CMS-855 form. To expedite the processing of your application, please use the internet-based Provider Enrollment, Chain, and Ownership System (PECOS).

How to update your Medicaid enrollment record

Florida
To update your addresses with Medicaid, you have two choices.

• Access Medicaid's secure web portal, click on "Demographics" and then "Address," to update the address.
• Contact Medicaid's provider enrollment customer service lines at 1-800-289-7799 (option 4), and they will fax the appropriate paperwork to you.

Medicaid also requires a notarized copy of your W9 -- showing your new address -- which may be submitted via fax. Their fax number is 1-866-270-1497. 

You may use Medicaid's web portal to create a fax coversheet, which should include Attention: Provider Enrollment. Medicaid also recommends you add your provider ID number to all pages within your document (including the fax cover sheet). 

Puerto Rico
To update your addresses with Medicaid, you have two choices.

• Login to the Provider Secure Communications (PSC) Portal of the Puerto Rico Medicaid Program website, click on the “Demographics” link at the top of the page. A list of addresses associated with your service locations will display.
  • To update your information, click the “edit” link next to the address needing to be updated.
• Contact Medicaid's provider enrollment customer service line at (787) 641-4200, and they will fax the appropriate paperwork to you.

Medicaid also requires a notarized copy of your W9 -- showing your new address -- which may be submitted via fax. Their fax number is (787) 763-5250. Medicaid also recommends you add your provider ID number to all pages within your document (including the fax cover sheet).

U.S. Virgin Islands
To update your addresses with Medicaid:

• Access the USVI Medicaid Online Portal, hover over the "Reference Material" section at the top of the page and select the Forms hyperlink. The Forms hyperlink contains documents used to request an authorization, change an address, the enrollment application, and other important documents.

  • Complete the USVI Medicaid Program Provider Change of Address form to document a change of address, whether mailing or physical. Note: This form must be returned with an original signature to VI Medicaid Program Provider Enrollment department:

    VI Medicaid Program Provider Enrollment
    Department of Human Services
    1303 Hospital Ground
    Knud Hansen Complex, Bldg. A
    St. Thomas, USVI 00802

Contact Medicaid's provider enrollment customer service line at (340) 715-6929 for additional assistance.