Florida Medicaid Provider Bulletin Summer 2008 Banner

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Practioners:

Submitting Medicare Crossover Claims for J3490 and J9999

All claims for J3490 and J9999 should be on a CMS-1500 claim form as follows:

  • the recipient’s Medicare number in Field 1a;
  • the recipient’s Medicaid number in field 10d;
  • the NDC number in field 19;
  • the NPI in field 33A; and
  • the provider number in field 33B preceded by the acronym ID.
The Medicare EOMB and to the CMS-1500 along with medical documentation that includes a diagnosis; and physician/nurse signature documenting the drug, dosage, and route of administration for the date of service.

Medicare crossover claims are to be mailed to:

Agency for Health Care Administration
Medicaid Physician Services
2727 Mahan Drive, Mail Stop #20
Tallahassee, Florida 32308

This is only applicable for Medicare crossover claims with a J-code of J3490 or J9999. Once a drug is assigned a J-code, the correct J-code for that drug must be used and the claim sent to the Medicaid fiscal agent.

Claims involving only Medicaid are sent to the Medicaid fiscal agent.