benefits management
FAQ from UHC
These Questions and Answers About Medicare Cross-Over give you an overview of the process.
1) What is Medicare Cross-Over?
Medicare Cross-Over is the process by which Medicare automatically forwards medical claims to UnitedHealthcare for processing. In effect, a Medicare recipient has one stop shopping for submitting medical claims and there is no need for you to file twice!
2) Who can use Medicare Cross-Over?
Medicare Cross-Over is available to any Medicare-primary Con Edison, Inc. enrollee. That is, Medicare pays first, then claims are submitted electronically to UnitedHealthcare. It is available to both enrollees and their Medicare-eligible dependents, if they do not have group coverage from another source.
3) How do I enroll?
Just complete and return the Enrollment Form in the enclosed postage-paid envelope as soon as possible.
4) What claims are included?
Medicare Part B and Durable Medical Equipment claims are included. Medicare Part A and prescription drug expenses are not included.
5) Will Medicare Cross-Over help to speed up the claims payment process?
Since UnitedHealthcare will receive claims electronically from Medicare, the claims payment cycle should be shortened. You should receive reimbursement faster! However, any delay by Medicare will result in a delay of the submission of the claim to UnitedHealthcare.
6) Will my claims be paid differently under this new method?
No. The benefits of the Con Edison, Inc plan have not been changed. Only the paperwork has been eliminated for you.
7) Is there any cost to me for Medicare Cross-Over?
No. As a Con Edison, Inc plan enrollee, you will not be charged for claims processed through Medicare Cross-Over.
8) How will I know that Medicare has sent my claim to UnitedHealthcare?
You may receive an Explanation of Medicare Benefits (EOMB) from your Medicare carrier which will tell you that your claim has been forwarded to your "secondary carrier". (The EOMB may refer to your "secondary carrier" rather than UnitedHealthcare specifically.) If this message does not appear, you will have to submit the claim to UnitedHealthcare yourself.
9) What if I am not sure that Medicare sent my claim to UnitedHealthcare?
If you receive an EOMB from your Medicare carrier, always check your "Explanation of Medicare Benefits" (EOMB) first. It should contain a message indicating that your claim has been sent to your secondary carrier. If your EOMB does not state that your claim was forwarded, you will have to submit the claim yourself. If your Medicare carrier does not send you an EOMB, you will know that your claim was crossed over if your UnitedHealthcare Explanation of Benefits includes a summary of Medicare’s benefits. You may also call the Con Edison, Inc plan service number at 1-800-638-5199 any time you have a question.
10) Doesn’t my doctor file claims for me now?
Doctors are required to file claims only with Medicare. Even if your doctor does send the bill directly to UnitedHealthcare, the claim cannot be processed under the Con Edison, Inc plan until Medicare's payment information is received.
11) Will I ever need to submit my own claims?
Certain claims will still need to be submitted to UnitedHealthcare including Medicare Part A claims and prescription drug expenses. These types of expenses should continue to be filed as they have in the past.
12) I spend part of the year in Florida; my claims for medical expenses with my Florida doctor are handled by a Medicare office different from the one that handles claims from my doctor at home. Will I have automatic filing for all claims?
When UnitedHealthcare receives the completed Enrollment Form, they will initiate automatic filing with the Medicare administrator in your primary area of residence as indicated by your address on the form. If you reside in another area for part of the year, you can fill in the name of the additional state where you expect to have medical expenses on the Medicare Cross-Over Enrollment Form. By doing so, you will have automatic filing for those claims. Automatic filing is available in all 50 states.
13) If I have a Medicare Cross-Over question concerning the Con Edison, Inc plan, whom do I ask?
If you have any questions about anything involving your Con Edison, Inc plan medical claim, call UnitedHealthcare’s Con Edison, Inc Customer Service Unit at 1-800-638-5199. If you have any questions about your primary claim, you should call Medicare.
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