Medigap and Secondary Payer

In many areas of the United States, the Medicare intermediaries will automatically "crossover" some of your secondary insurance claims. This means you no longer need to track, print or transmit the secondary insurance. Medicare will give the "medigap" (secondary payer) insurance company all the information they need to process the claim and pay you. The way that Medicare is able to do this is with a special code that has been assigned to all "medigap" payers in the area covered by the Medicare Intermediary. For example: Transamerica is the Medicare intermediary for Medicare part B (physician) insurance coverage in the Los Angeles, California area. They have a list of codes that they call OCNA (Other Carrier Name and Address). These codes tell Transamerica which insurance company to "crossover" the primary payer information. You may ask: why don't they just look at the insurance company name and "cross it over"? One reason is that there are many ways that you might enter an insurance company name. You might enter Blue Cross for Blue Cross coverage, however, that does not say anything about which "Blue Cross". There are many Blue Cross offices and they all might have different contracts, codes, id numbers, etc. Also, you might abbreviate the name in a way that is clear to you, but is not programmed into the Transamerica computer. By using the code, they know what you mean and your insurance information will be "crossed over" and you will not be required to devise some elaborate method for tracking it. You may also ask: why does not Stratford put these numbers in the computer and maintain it like they do the "payer ID" numbers. The reason is: at this time, every Medicare intermediary has a different code scheme. At some point in the future maybe they will adopt the PAYERID numbers which are mandated by law. At that time, we may be able to maintain it for you.

At this time most private insurance companies are working on ways to do automatic "crossing over" of information to secondary payers. Soon, you probably will not be required to do anything special for secondary payers. The "ANSI 837" format for electronic claims can handle up to 2 secondary payers with the present specification. Stratford first sent a test for this type of transmission during the week of September 6, 1993, to Medicare of Northern California.

Electronic Medigap claims are setup by inserting the proper Medigap code in each crossover insurance. You can obtain the list of codes from your Medicare representative. You must revise each insurance company that crosses over and insert the proper Medigap code into the Medigap field. See Edit an Insurance/Payer