Crossover Claims Fixed, According to the Department of Medical Assistance Services (DMAS)

In early March, DMAS announced that crossover claims for nursing facility services with dates of service on or after November 1, 2014 were not processing correctly.  Specifically, Edit 364 (Primary Carrier Payment Equals/Exceeds VMAP'S) was not posting for claims where the Medicare paid amount exceeded the DMAS allowed amount.  DMAS has announced that they “implemented the fix on March 29, 2015 to correct the crossover claim issue causing nursing facility services to be paid incorrectly. Affected claims will be reprocessed beginning April 1, 2015. The corrected claims will be available on the April 10, 2015 remittance advice. Questions about this issue may be sent to NFPayment@dmas.virginia.gov.”