Glossary
Crossover claim
Short answer
A crossover claim is a Medicare claim that the Medicare contractor forwards automatically to the patient's secondary payer, such as Medicaid or a Medigap plan, after Medicare adjudicates it, so the provider does not have to file the secondary claim separately.
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Last reviewed by the Remitwright billing team. Editorial policy
Also written asMedicare crossover
Medicare contractors hold agreements with secondary payers under which Medicare sends the adjudicated claim and its payment data on to the secondary after it pays. The Medicare remittance tells you when that has happened: the claim carries a remark showing it was forwarded, along with the name of the payer it went to. The secondary then adjudicates the balance and issues its own remittance. Medicaid programs and Medigap plans are the usual crossover partners, but other plans can take part.
When it works, a secondary claim costs you nothing. When it fails, you find out only because the secondary payment never arrives. The usual reasons: the secondary coverage is not on the patient’s Medicare record, the Medicare record names a different plan, the secondary payer’s provider file does not match the NPI or tax ID on the claim, or Medicare adjusted the claim after the first forward and the adjustment did not cross. Each of those leaves the balance in secondary A/R with no activity to show for it.
The mistake is filing the secondary claim while a crossover is pending, which produces a duplicate denial at the secondary and two records to untangle. Wait for the forwarding remark on the Medicare remittance, allow the secondary its usual processing time, and then follow up. When the Medicare remit shows no forward, file the secondary yourself with the primary payment data.
Crossover claim in practice
A dual-eligible patient's claim pays at Medicare, and the remittance shows it was forwarded to the state Medicaid plan. The Medicaid payment never arrives, and on inquiry the state has no record of the claim, so the biller files it directly with the Medicare payment data. Hypothetical example.
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