what is a medicare crossover claim?

A Medicare cross-over is a claim that Medicare sends to another insurer for secondary payment. When a Medicare beneficiary is a dual eligible – meaning they have Medicare and Medicaid

– their Medicare claims should cross-over to Medicaid, which would cover Medicare cost sharing (i.e., deductibles, co-pays and coinsurance).

Full Answer

How does the Medicare crossover claim system work?

 · A crossover claim is a claim for a recipient who is eligible for both Medicare and Medicaid, where Medicare pays a portion of the claim, and Medicaid is billed for any remaining deductible and/or coinsurance. A Coordination of Benefits Contractor (COBC) is used to electronically, automatically cross over claims billed to Medicaid for eligible recipients.

How to set up Medicare crossover?

 · CROSSOVER CLAIMS The crossover process allows providers to submit a single claim for individuals dually eligible for Medicare and Medicaid, or qualified Medicare beneficiaries eligible for Medicaid payment of coinsurance and deductible to a Medicare fiscal intermediary, and also have it processed for Medicaid reimbursement.

What does crossover mean in medical insurance terms?

A Medicare cross-over is a claim that Medicare sends to another insurer for secondary payment. When a Medicare beneficiary is a dual eligible – meaning they have Medicare and Medicaid – their Medicare claims should cross-over to Medicaid, which would cover Medicare cost sharing (i.e., deductibles, co-pays and coinsurance). Claims can also cross-over from Medicare to …

What is a crossover professional claim?

In health insurance, a "crossover claim" occurs when a person eligible for Medicare and Medicaid receives health care services covered by both programs. The crossover claims process is designed to ensure the bill gets paid properly, and doesn't get paid twice.

How does Medicare crossover claims work?

1. What is meant by the crossover payment? When Medicaid providers submit claims to Medicare for Medicare/Medicaid beneficiaries, Medicare will pay the claim, apply a deductible/coinsurance or co-pay amount and then automatically forward the claim to Medicaid.

How do you identify a Medicare crossover claim?

Your Medicare remittance will have an indicator that will show the claim was an automatic cross over to Medicaid. When the indicator appears on the Medicare remittance you will not bill Medicaid for those clients.

When would you use a crossover claim?

In health insurance, a "crossover claim" occurs when a person eligible for Medicare and Medicaid receives health care services covered by both programs. The crossover claims process is designed to ensure the bill gets paid properly, and doesn't get paid twice.

Does Medicare automatically forward claims to secondary insurance?

Medicare will send the secondary claims automatically if the secondary insurance information is on the claim. As of now, we have to submit to primary and once the payments are received than we submit the secondary.

How is Medicare crossover set up?

How do Medicare claims cross over to Medi-Cal? Medicare uses a Coordination of Benefits Contractor (COBC) to electronically, automatically cross over claims billed to the Medicare Part A, Part B and Durable Medical Equipment (DME) contractors for Medicare/Medi-Cal eligible recipients.

Does Medicare cross over to Medicaid?

Medicare uses a consolidated Coordination of Benefits Contractor (COBC) to automatically cross over to Medi-Cal claims billed to any Medicare contractor for Medicare/Medi-Cal eligible recipients.

Does Medicare crossover to AARP?

Things to remember: When Medicare does not crossover your claims to the AARP Medicare Supplement Plans, you will need to make sure this CO253 adjustment is applied before you electronically submit to AARP as a secondary payer.

What is a crossover only application?

Crossover Only providers are those providers who are enrolled in Medicare, not enrolled in Medi-Cal, and provide services to dual-eligible beneficiaries. Dual-eligible beneficiaries are those beneficiaries who are eligible for coverage by Medicare (either Medicare Part A, Part B or both) and Medi-Cal.

When submitting a secondary claim what fields will the secondary insurance be in?

Secondary insurance of the patient is chosen as primary insurance for this secondary claim; primary insurance in the primary claim is chosen as secondary insurance in the secondary claim. Payment received from primary payer should be put in 'Amount Paid (Copay)(29)' field in Step-2 of Secondary claim wizard.

Will Medicare pay secondary if primary denies?

If your primary insurance denies coverage, secondary insurance may or may not pay some part of the cost, depending on the insurance. If you do not have primary insurance, your secondary insurance may make little or no payment for your health care costs.

What determines if Medicare is primary or secondary?

The insurance that pays first (primary payer) pays up to the limits of its coverage. The one that pays second (secondary payer) only pays if there are costs the primary insurer didn't cover. The secondary payer (which may be Medicare) may not pay all the remaining costs.

How do you determine which insurance is primary and which is secondary?

The insurance that pays first is called the primary payer. The primary payer pays up to the limits of its coverage. The insurance that pays second is called the secondary payer. The secondary payer only pays if there are costs the primary insurer didn't cover.

How to find if a Medicare claim is crossed over?

If a claim is crossed over, you will receive a message beneath the patient’s claim information on the Payment Register/Remittance Advice that indicates the claim was forwarded to the carrier.

How long does it take for Medicare to cross over to Blue Cross?

When a Medicare claim has crossed over, providers are to wait 30 calendar days from the Medicare remittance date before submitting a claim to Blue Cross and Blue Shield of Louisiana. Claims you submit to the Medicare intermediary will be crossed over to Blue Cross only after they have been processed by Medicare.

What happens if a remittance does not contain a message similar to the above?

If the remittance does not contain a message similar to the above, the claim was not crossed over to the payer. This claim must be filed on paper to the Plan listed on the member’s ID card. The following claims are excluded from the crossover process for Blue Cross:

What is a CIF for a crossover claim?

A CIF is used to initiate an adjustment or correction on a claim. The four ways to use a. CIF for a crossover claim are: • Reconsideration of a denied claim. • Trace a claim (direct billed claims only) • Adjustment for an overpayment or underpayment. • Adjustment related to a Medicare adjustment.

Can a CIF be submitted to a direct billing crossover?

However a CIF must be submitted to trace a direct billed crossover claim. Submit a crossover claim (CMS-1500/UB-04 with an MRN or Medicare RA) to trace an automatic crossover claim.

What is the RA code for Medicare?

When a claim is crossed over to MDHHS, a remittance advice (RA) will be generated from the fiscal intermediary with the details of the Medicare payment and Remark Code MA07 (the claim information has also been forwarded to Medicaid for review). If this remark does not appear on the fiscal intermediary’s RA, a separate claim will have to be submitted to MDHHS.

Does MDHHS accept Medicare Part A?

MDHHS accepts Medicare Part A institutional claims (inpatient and outpatient) and Medicare Part B professional claims processed through the CMS Coordinator of Benefits Contractor, Group Health, Inc. (GHI). Claim adjudication will be based on the provider NPI number reported on the claim submitted to Medicare.

What is a cross-over claim?

What is a Medicare cross-over claim? A Medicare cross-over is a claim that Medicare sends to another insurer for secondary payment. When a Medicare beneficiary is a dual eligible – meaning they have Medicare and Medicaid – their Medicare claims should cross-over to Medicaid, which would cover Medicare cost sharing (i.e., deductibles, ...

Can you cross over Medicare to Medigap?

Claims can also cross-over from Medicare to Medigap plans, which pay for deductibles, co-pays and coinsurance.

What is a crossover claim?

In health insurance, a "crossover claim" occurs when a person eligible for Medicare and Medicaid receives health care services covered by both programs. The crossover claims process is designed to ensure the bill gets paid properly, and doesn't get paid twice. Advertisement.

Who sets rules for crossover claims?

Rules for crossover claims are set by the federal Centers for Medicare & Medicaid Services. Health-care providers submit all crossover claims to Medicare. Medicare assesses the claim, pays its portion of the bill, and then submits the remaining claim to Medicaid.

Is Medicare a federal program?

Medicare is a federal program that provides health care coverage to people age 65 and older, as well as disabled adults. Medicaid is a combined federal-state program that covers low-income people regardless of age. Because of overlaps in eligibility, some people may be covered by both programs.

What is a Medicare crossover claim?

Medicare crossover claims are claims that have been approved for payment by Medicare and sent to Medicaid for payment towards the Medicare deductible and coinsurance within Medicaid program limits.

What happens after a Medicare crossover claim is approved?

After Medicare processes the claim, it sends the provider an explanation of Medicare benefits. If Medicare has approved the claim, Medicaid can pay towards the deductible and coinsurance according to Medicaid policy. Medicare crossover claims are submitted to the Medicaid fiscal agent by one of the following methods: ...

What is a Medicaid recipient who is also receiving Medicare benefits called?

A Medicaid recipient who is also receiving Medicare benefits is called “dually eligible.”

Does Medicare pay for crossover?

Medicaid will not pay a crossover claim when it has been paid by Medicare in an amount that is the same or more than Medicaid’s rate for the specified service. Medicaid will not pay a crossover claim when it is for a service that is not covered by the Medicaid program.

What is the MA18 code for Medicare?

The Medicare Remittance will include a Remittance Remark Code of MA18 indicating the claim has been forwarded to a supplemental payer and will name NY Medicaid as that payer

Does New York State Medicaid receive crossover claims?

New York State Medicaid will receive Medicare crossover claims from the Coordination of Benefits Contractor (COBC), Group Health Inc. (GHI). The various Medicare payers across the State will all transmit paid claims for Medicare/Medicaid beneficiaries to GHI. GHI will transmit the claims to eMedNY.

Does Medicare remittance show cross over?

Your Medicare remittance will have an indicator that will show the claim was an automatic cross over to Medicaid. When the indicator appears on the Medicare remittance you will not bill Medicaid for those clients