What is the Crossover Claim?

A cross payment is a claim for recipients who are eligible for both Medicare and Medicaid, with Medicare paying part of the claim and Medicaid billing the remainder of the deductible and/or coinsurance. The Coordination of Benefits Contractor (COBC) is used to automatically electronically transmit Medicaid billed claims to eligible recipients.

Your health insurance transfer will have indicators to show that your health insurance claim has automatically transferred to your health insurance. If you see an indicator on your Medicare remittance, you will not be charged Medicaid for that client. Health care providers can check the health insurance premium transfer notice/transfer comment code to see if the number of claims has been exceeded.

There are two different programs.

Medicare is a federal program that provides health care for adults with disabilities and people over age 65. Medicaid is a federal program for low-income people, regardless of age. Because of overlapping eligibility, some people may be eligible for coverage under both programs.

Handles cross-billing claims.

Cross-billing rules are set by the federal Centers for Medicare & Medicaid Services. The provider submits all cross-claims to Medicare. Medicare estimates the bill, pays part of the bill, and then sends the rest of the bill to Medicaid. How much Medicaid will be paid depends on the rules of the state where the bill is received. When Medicaid processes a portion of the bill, the claim stops and the provider can bill the patient or the patient’s additional insurer for the unpaid portion.

Prevents cross-claims from being denied.

If a Medicaid cross-claim is denied, the reason may be an address registered with Medicaid and Medicaid under the Medicaid program. If Medicare overlaps your Medicaid application, the following address fields are filled out: This is the default address and the payment address (or money order address) (if it is different on Medicare). You can make sure that both Medicare and Medicaid have exactly the same address on file. If the Medicaid file does not have the same address, Medicaid will deny the claim.