Clarification Of Traditional Medicaid & Care Select Claim Submission Addresses
Many claim denials are the result of sending claims to the wrong address or not including the required information on/with the claim. The following table provides a description of the various claim types, required attachments, special notes/considerations, and the correct Medicaid address.
| Description/Claim Type | Attachments Required | Special Notes | Claim Address |
| Original Medicare Part B Primary Coverage
Claim Type: Medical Crossover |
If Medicare made payment in any amount no attachment is required.
If the claim was applied in whole to coinsurance and deductible and was paid $0 the MRN must be attached. |
Crossovers include only those services covered and allowed by Medicare.
Complete Item 22 of paper claim with crossover data. Services denied by Medicare are not considered crossovers, refer to Medicaid Medical Claims for instructions. |
Medical Crossover Claims
PO Box 7267 Indianapolis, IN 46207-7367 AMPlus Tip: be sure the correct address prints on the face of the claim as well as on the envelope. |
| Medicaid Only – No Other Insurance Coverage
Claim Type: Medical Claim |
Services billed with unlisted or unspecified CPT/HCPCS codes must include documentation such as the office note, operative report, or detailed description of item/service provided. Manufacturer invoice is required for unlisted supply codes and other manually prices supplies/items. Provider created invoices will only be accepted in limited situations.
Claims requiring attachments may be submitted on paper with the applicable attachment(s) or claims may be billed electronically followed by hardcopy paper submission of the applicable documentation with the Attachment Cover Page. The attachment control number must be indicated on the electronic claim transmission. |
Any documents sent with a claim should contain the member’s RID number, provider name/NPI, and date of service. Providing this information makes it possible for claims and documents to be matched up in the event they become separated.
Denied medical services (CPT codes 99201-99499, 70000-90000) may be refiled as a new claim. Denied surgical services (10000-69999) can only be refiled if all details have been denied. If any detail/line item was paid, the denied lines cannot be refiled as a new claim. An adjustment to the original claim must be completed either electronically or via paper adjustment. Incorrect refiling will result in a duplicate denial. |
Medical Claims
PO Box 7269 Indianapolis, IN 46207-7269 See BT201028 for additional information regarding invoice requirements. AMPlus Tip: be sure the correct address prints on the face of the claim as well as on the envelope. |
| Commercial Insurance Primary Coverage
Claim Type: Medical Claim |
If the insurer paid any amount on the claim, the insurer’s EOB/EOP is not required but Item 29 must reflect the actual amount paid by the other insurer. Even if an EOB/EOP is forwarded with the claim, the amount indicated in Item 29 is what will be used as the other insurer payment. Contractual write-off amounts should be included as part of the balance due, not the amount paid.
If the other insurer denied the services for any reason, the EOB/EOP must be submitted with the claim or as a follow up attachment using the Attachment Cover Page. |
If any other insurer is listed via the eligibility verification system you must submit a claim to the other insurer before Medicaid will correctly process your claim. If the policy is no longer active, fax the denial notice stating no coverage to the Medicaid Third Party Liability Department at 317-488-5217. Be sure to indicate the member’s Medicaid RID number on the denial notice. Sending the denial notice with the claim will allow the claim to process but will not trigger the TPL Department to review/end-date the policy. | Medical Claims
PO Box 7269 Indianapolis, IN 46207-7269 AMPlus Tip: be sure the correct address prints on the face of the claim as well as on the envelope. |
| Medicare HMO Primary Coverage/Medicare Replacement Plan
Claim Type: Medical Claim |
The Medicare Replacement Plan EOB/EOP is ALWAYS required, regardless of whether the Medicare HMO (Medicare Replacement Plan) paid or denied the claim in whole or in part.
Write or stamp: Medicare Replacement Plan on the top of the claim and the top of the EOB/EOP. Failure to mark the claim as a Medicare Replacement may result in incorrect denial/processing of the claim. |
Even though the plan is a Medicare plan, it is not considered a crossover claim. Only claims paid by Original Medicare Part A and B are considered crossovers. Medicare Replacement Plan claims are treated in the same manner as other TPL claims, with the exception that the EOB/EOP is always required. | Medical Claims
PO Box 7269 Indianapolis, IN 46207-7269 AMPlus Tip: be sure the claim and attachment are marked as a Medicare Replacement Plan and that the correct address prints on the face of the claim as well as on the envelope. |
