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Last Modified: 4/5/2022 Location: FL, PR, USVI Business: Part A, Part B

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:
1. National provider identifier (NPI)
2. NPI to taxonomy code (if applicable)
3. NPI to ZIP code

What can you do to avoid rejects?

Verify that you have the exact same addresses on file with both Medicare and Medicaid
Make sure your addresses are current and in the ZIP+4 external link (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) external link.

How to update your Medicaid enrollment record

To update your addresses with Medicaid, you have two choices.
Access Medicaid's secure web portal external link, 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 that you add your provider ID number to all pages within your document (including the fax cover sheet).
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.