Medicare AdvantageDocumentationHigh impact
Medicare Explanation of Benefits Documentation for Medicare Crossover Claims
Maryland Medicaid·MD·Hospital
Effective date
Jun 3, 2025
We identified it
Jun 20, 2026
Summary
Maryland Medicaid now requires specific documentation for Medicare crossover claims submitted to MMIS-II. Hospitals must submit the 835 EOB, UB04 claim form, and Medicare EOMB together, with matching recipient names, total charges, dates of service, and revenue codes. For outpatient claims with physician-administered drugs, the NDC must also be included. Claims missing these elements or with mismatched data will be returned.
Action Required
Effective immediately (June 3, 2025): Billing team must update Medicare crossover claim submission procedures for Maryland Medicaid. INPATIENT CLAIMS: Ensure all three documents (835 EOB from Medicare/MA plan, UB04 claim form, and Medicare EOMB) are submitted together with MMIS-II. Verify that recipient name, total charges, and dates of service match exactly across all documents before submission. Confirm Medicare paid date and paid amount are documented on the EOMB. OUTPATIENT CLAIMS: Verify revenue codes on the UB04 claim form exactly match revenue codes listed on the Medicare/MA EOMB. Do not submit claims if revenue codes are missing from the EOMB. For physician-administered drug claims, ensure NDC is included on the UB04. Verify recipient name, total charges, and dates of service match across all documents. Update billing software validation rules to enforce these matching requirements and flag mismatches before submission. Train all billing staff on these requirements. Failure to comply will result in claim denials and returns from Maryland Medicaid. Contact Institutional Provider Relations Unit at (410)767-5457 or (410)767-5503, Option 3 with questions.