TO:  All Renal Dialysis Facility Providers

Medicare Crossover Changes:

Effective February 1, 2011, renal dialysis crossover claims will be received from Medicare and will be processed by Medicaid for all renal dialysis providers. 

*Note:  Crossover claims with Dates of Service prior to January 1, 2011 that crossover from Medicare will not pay correctly.  These crossover claims must be electronically submitted through the previous claim submission process to Medicaid.

Medicare claims billed by renal dialysis providers will cross over directly from Medicare and will be processed by Medicaid.  Providers are limited to the following codes on Medicare crossover claims.  Future Medicare revisions may require code updates to this table:

Medicaid Changes: 

All Medicaid services beginning with dates of service January 1, 2011, and thereafter, must be billed according to the following policy. Medicaid’s new requirements mirror Medicare’s as closely as possible.

*EPO and Aranasp Monitoring Policy: 

Medicaid is requiring providers include the GS modifier, the ED modifier, or the EE modifiers in mirroring Medicare’s policy, refer to Chapter 8 of the Medicare Claims Processing Manual for further definition.  These modifiers will be considered ‘informational only’ when billed to Medicaid and no reductions in payment will be made for straight Medicaid claims.  Medicaid expects the provider to adhere to the strict definitions defined below:

Providers may contact Jerri Jackson, RN, BSN, at 334-242-5630 or e-mail at jerri.jackson@medicaid.alabama.gov if you have any questions.